§ Order for Second reading read.
§ 4.4 p.m.
§ The Minister of State, Home Office (Miss Alice Bacon)
I beg to move, That the Bill be now read a Second time.
A few weeks ago we had a valuable debate which was initiated by the right hon. Member for Ashford (Mr. Deedes) and which ranged widely over the many difficult social problems arising from the misuse of drugs. In that debate, my right hon. Friend the Minister of Health and I outlined the Government's attitude to the recommendations made by the Inter-Departmental Committee on Drug Addiction in its second Report, and we then foreshadowed the introduction of the Bill which is before us today.
It is fitting that at the outset I should pay tribute on behalf of the Government to the late Lord Brain, who was Chairman of the Committee, and to his colleagues for their careful study and the clear guidance they have given us. The matters they were called upon to consider have challenged the wisdom of experts in many countries for many years.
It is a measure of the Committee's good work that its recommendations have won general acceptance in principle from both the medical profession and the public. I have seen criticism that the Committee did not look at the whole drug problem before recommending action to deal with heroin addiction. But the scope of the Committee's inquiry was determined by the terms of reference it was given when it was reconvened in July, 1964, and those terms of reference were confined to the prescribing of addictive drugs by doctors, a matter which then appeared to be in need of review in the light of evidence of increasing addiction.
However, the Committee recommended that a Standing Advisory Committee should survey, and advise upon, the whole field of misuse of drugs, and that new Committee is now well established. We had hoped that Lord Brain would launch the Committee, and he had agreed to do so. Our plans suffered a severe setback with his untimely death. We have, however, been fortunate to secure the services of Sir Edward Wayne, Regius 473 Professor of Medicine at the University of Glasgow.
If I do not speak today about the wider aspects of the problem, it is not for want of concern about them, or because I do not realise that addiction to hard drugs has its roots in the larger field of drug abuse.
The Bill is short, but it paves the way to a major change in the organisation of treatment for addicts. I stress the word "organisation", because to a large extent the basic principle of what has become known as the British system for the treatment of addiction will remain unaltered. In the United Kingdom, unlike many other countries, the addict has always been regarded as a sick person and not as a criminal, in both its Reports, the Brain Committee reaffirmed that principle, and the Government fully accept it. In this country, doctors have always had the right to use drugs of their choice in the treatment of organic disease, injury and related conditions. We intend to leave that right untouched.
Since the First World War, doctors have also been free to administer, supply or prescribe dangerous drugs to addicts. In doing so, they have been expected to comply with certain principles laid down by a Departmental Committee, the Rolleston Committee, which examined the matter in 1926.
Those principles presuppose, first of all, that the general practitioner will make every effort to cure the addiction. If those efforts fail, however, the doctor may continue to prescribe dangerous drugs—and now I quote from the Report of the Rolleston Committee—'… where complete withdrawal produces serious symptoms which cannot be treated under the ordinary conditions of general practice, or where the patient, while capable of leading a useful and fairly normal life so long as he takes certain non-progressive quantities. usually small, of the drug of addiction, ceases to be able to do so when the regulated allowance is withdrawn.In 1961, the Brain Committee, in its first Report, gave general support to the principles laid down by the Rolleston Committee, but expressed its belief that institutional treatment only was likely to be satisfactory.
The Committee did not then recommend the establishment of treatment centres because it believed that addiction was on 474 too small a scale to justify this. The House will recall that, in 1960, the total number of known addicts was 454; the number of heroin addicts was 68. In 1964, the Brain Committee was reconvened to review a changed situation. By then, the total number of known addicts had risen to 753 and of heroin addicts to 342. Heroin addicts under the age of 20 had risen from one in 1960 to 40 in 1964; and heroin addicts between the ages of 20 and 34 from 52 in 1960 to 219 in 1964.
I want now to give the up-to-date picture for 1965 and 1966. In 1965, the total number of known addicts was 927 and 521 of them were addicted to heroin. In 1966—and I stress that the figures are still provisional—there were 1,139 known addicts, of whom 749 were heroin addicts. This is a net increase of 212 more addicts between 1965 and 1966 and a net increase of 228 heroin addicts in that period. Thus, in the last three years, the number of known heroin addicts has more than doubled, from 342 to 749. That heroin addiction is a real problem is clearly shown by the fact that 90 per cent. of the addicts whose addiction was not therapeutic in origin were addicted to heroin and that about 200 of the 749 heroin addicts were under the age of 20.
What have been the factors responsible for these increases? As the House will be aware, the Brain Committee concluded that over-prescribing of heroin and cocaine by a small number of doctors had created a surplus attracting new addicts. If over-prescribing has been the source of drugs for the growing number of addicts, it is right also to ask what has been the motive drawing more and more young people to join their ranks.
I must admit that we know all too little about this aspect of the problem. Doctors are now faced by numbers of young addicts of a type not known before in this country. By their numbers and by their rejection of any society but their own, and by their pursuit of new addicts, they threaten to overload the capacity and to cloud the judgment of the most dedicated general practitioners. I do not wish to under-value in any way the patient and sympathetic support and help given by a number of doctors to many difficult addict 475 patients. We have already had experience of the difficulties that arise when a general practitioner feels unable to continue to care for a large number of addicts. The risk is high when a doctor falls out that his patients may look not to another doctor, but to other addicts and to illicit sources for their supplies.
I have quoted the figures for known addicts. It is anyone's guess how many others stand behind them and may be supported by them. Some hon. Members may feel that even these figures are still small. That is true, but it is the trends which are alarming. Hon. Members may recall that, earlier this year, an American research institute estimated that there might be conceivably 11,000 or more heroin addicts in this country by 1972 if recent trends continue. This is one measure of the future threat.
The immediate problems are simple to express. First, can we organise the supply of drugs to the addict so that he receives no more than he needs? Secondly, can we do this in such a way that the addict is not only discouraged from making use of illegitimate sources of supply but feels encouraged to seek treatment, cure and rehabilitation? I think that there is a delicate balance to be sought here. The addict must feel that his future lies with the doctor and not the drug pedlar and society must be assured that the addict cannot easily become a pedlar of his own medicine.
The Government have, therefore, decided that the treatment of addicts, particularly of the heroin and cocaine addicts, must be put on a more organised and resourceful basis as a matter of urgency. In the debate of 30th January, my right hon. Friend the Minister of Health explained his plans for treatment and rehabilitation. He will no doubt have more to say about these plans when he speaks later in the debate.
The overall plan in the Bill is based on four important measures—notification of addicts, the setting up of advisory panels to which doctors may refer if in doubt as to whether a patient is an addict or not, the provision of special treatment centres, and research.
Why should we need notification? We need it because the present system of 476 identifying addicts is slow and cumbersome and because central records may help doctors to deal more knowledgeably with new addict patients. We want advisory panels to help the general practitioners under the new arrangements more readily to detect addicts.
Why treatment centres? We need them because the Brain Committee laid stress in both its Reports on the view that institutional treatment offered the only satisfactory hope of cure and because the staffing and other facilities at treatment centres should offer a better assurance both of more accurate prescribing and more comprehensive treatment. As for research—we still know too little about the motivation of addicts and the most effective ways of dealing with them.
I said earlier that the medical profession had expressed general agreement with the principles of the Brain Committee's recommendations. I should add that an outline scheme of the legislation was sent last October to all the interested professional organisations and no objections were received. The Council on Tribunals has been fully consulted about the proposed machinery of enforcement and is in agreement with the proposals. The Bill has been prepared on the basis of the outline scheme.
I come now to the Bill. It is concerned solely with those addicted to "hard" drugs, particularly with those pitiable creatures whose enthralment brings them late at night to the pharmacies in Piccadilly and elsewhere to obtain their next "fix". The Bill is designed to help these addicts, to stop them using illicit sources, with their rich harvest of human misery and degradation, and to prevent addiction from spreading. Legislation cannot, of course, cure addiction or abolish the drug problem overnight, but the Bill paves the way, as I have said, for a new organisation to deal with the "hard" drug problem.
Clause 1 extends the powers to make regulations conferred on the Home Secretary by Section 11 of the 1965 Act and under the extended powers he will be able to make regulations to require the notification of addicts by medical practitioners and to prohibit medical practitioners, except under licence, from providing addicts with specified drugs.
My right hon. Friend the Home Secretary intends that the medical profession 477 shall be fully consulted in the preparation of these important regulations. The regulations will, among other things, have to define addiction. They will have to specify the drugs which are not to be provided to addicts for the treatment of their addiction except under licence.
My right hon. Friend the Home Secretary intends to specify initially heroin and cocaine but the power will be available to specify other dangerous drugs later on should experience prove this to be desirable. The Brain Committee gave reasons for the introduction of special controls over heroin and cocaine. The figures I gave just now show that these are the drugs to which most of the new addicts have become addicted.
The regulations will have to lay down the circumstances in which notifications to a central authority—which, it is envisaged, will be the Home Office—will be required, and the procedure for notification. Notification will have no legal consequences of any kind for the addict. It will merely indicate to the central authority that a particular doctor has attended upon a patient whom he considers, or suspects to be, addicted. The doctor's notification may have to be verified in certain cases; and this would be done by inquiry of the doctor through the regional medical officers of the health departments. The central record itself will be used, as the Brain Committee recommended, to answer doctors' inquiries. It will also be used for research and statistical purposes.
At present, the Home Office obtains information about prescriptions of dangerous drugs from routine police examination of records kept by pharmacists. This routine scrutiny will be continued, and will provide a means of ascertaining addicts who have not been notified. The police will be informed, as at present, when a case of addiction is made known to the Home Office, so that the relevant prescriptions can be taken into account in the routine police scrutiny of the pharmacists' registers.
As regards the advisory panels to which I referred just now, no provision is necessary in the Bill. Advisory panels will be organised under the National Health Service.
The regulations will make provision to allow doctors to continue, without restriction, 478 to prescribe any dangerous drug in the course of medical treatment unrelated to addiction. If I may put that another way, the regulations will not prevent a doctor from prescribing one of the specified drugs—say, heroin—to an addict where that drug is needed for a medical purpose other than the treatment of addiction.
I come now to the enforcement provisions of the Bill. Because notification of addicts and prescribing for addicts closely involve the exercise of professional judgment, the Brain Committee felt that it would be inappropriate for a court of law to deal with the doctor who seemed not to have complied with the new requirements which it was proposing. It suggested that the appropriate tribunal for this purpose would be the Disciplinary Committee of the General Medical Council, which deals with questions of infamous conduct in a professional respect. This recommendation was considered by the General Medical Council, but it felt that it would be more appropriate to set up a special medical tribunal.
Although we would all hope that enforcement machinery would never need to be used, it must, nevertheless, be provided and we have, therefore, devised another solution, which includes provision for an "appeal" stage which hon. Members will consider to be necessary. This will not prejudice the General Medical Council taking up any case where a doctor's prescribing appears to involve infamous conduct in a professional respect.
The Brain Committee recommended that the sanction for enforcement of its proposals on notification and prescribing should be withdrawal of a doctor's authority to prescribe, supply and administer dangerous drugs. Clause 1 gives effect to this. Contravention of the new regulations would not—I emphasise "not"—be a criminal offence. A doctor would be liable to conviction before a court only if, after withdrawal of his authority, he supplied or prescribed prohibited drugs.
Clause 2 provides for the investigation of contraventions to be undertaken by a special tribunal to be constituted as laid down in Part I of the Schedule. In this way doctors will themselves play 479 a major part in determining the professional issues involved.
The provisions of Clauses 2 and 3 and of the Schedule may appear somewhat involved. We believe, however, that doctors are fully entitled to proper protection in relation to their dealings with addicts, and provision for this purpose, with proper safeguards at all stages, must necessarily be elaborate. We shall be very ready to consider any suggestions for improving the effectiveness of the procedure in the Bill at a later stage.
How will contraventions, if any, come to light? I mentioned just now that the police would continue to scrutinise records of prescriptions. The Brain Committee described clearly in paragraph 32 of its Report how information from this source would be used to identify any case of unauthorised prescribing. Contraventions may come to light in a variety of other circumstances. For example, an addict may be injured in an accident and come to notice in a hospital, or he may appear before a court and be found on medical examination to be addicted.
It will be the duty of the Home Office drugs inspectors to make the fullest inquiry into any unaccountable prescribing or apparent failure to notify an addict. As envisaged by the Brain Committee, the individual doctor will be interviewed by a regional medical officer of the health department and given every opportunity to explain his treatment of the persons suspected to have been an addict at the relevant time. If, at that stage, it is clear that the doctor had taken all proper safeguards, including consultation with an advisory panel, that might well be the end of the matter. If, after full informal inquiry, there appears to be a case for formal investigation, the Secretary of State will refer it to a tribunal.
Innocent failures to notify would not attract any sanction. What the machinery is primarily designed to deal with is the case, if it should ever occur, of the doctor who wilfully refuses to acknowledge that a patient is an addict and resolutely continues to prescribe restricted drugs for him.
Hon. Members will see that paragraph 4 of the Schedule provides for the Lord Chancellor to make rules of procedure 480 to be followed by the tribunal. These rules will provide necessary safeguards for the doctor. They will, in particular provide for the doctor, among other things, to be legally represented.
I should like to draw the attention of the House to the provision in paragraphs 10 and 16 of the Schedule. These give the tribunal and the advisory body power to recommend payment of the expenses incurred by a doctor in proceedings before them. This is intended to deal with the case in which the doctor is judged not to have a degree of culpability which would make it reasonable for him to have to bear the expenses of legal representation.
I can deal very briefly with the remaining Clauses. Clause 3 contains supplementing provisions. Subsection (5) empowers the Secretary of State to give a direction at any time cancelling or suspending a direction withdrawing a doctor's authority to provide patients with such drugs as are specified in the direction. Each case of withdrawal will be kept under review with a view to restoring the doctor's authority as soon as it is considered appropriate to do so.
Clause 4 enables regulations under the 1965 Act to provide that the contravention of particular regulations shall not constitute a criminal offence under Section 13 of that Act. It will also allow the Secretary of State to apply the safeguards of the tribunal and advisory body procedure in cases in which a court has found a doctor guilty of an offence under the Act and consideration is being given to withdrawing the doctor's authority. In this way it will be possible to deal with all withdrawals by a common procedure.
So much for the terms of the Bill.
Hon. Members will observe that it does not give effect to the Brain Committee's recommendation that there should be a power to detain addicts who wish to break off voluntary treatment.
My right hon. Friend the Minister of Health explained on 30th January the Government's reasons for thinking that it would be right to proceed without this power until further experience shows that it is essential. With this exception the Bill gives effect to the main recommendations of the Committee, and as it stands this is its sole purpose.
481 As I said earlier, we are well aware that this is not the whole of the problem of drug abuse.
Studies of other aspects of this problem, including proposals for research, are being undertaken in the Home Office and the Health Departments, and by the new Advisory Committee on Drug Dependence. It is possible that some of them will point to the need for further legislative action.
The police are resolutely tackling the problem of illicit drug trafficking. My right hon. Friend the Home Secretary is examining, as a matter of urgency, the controls exercised over and the arrangements made for the safe keeping of drugs in the premises of manufacturers, wholesalers, and pharmacists not only dangerous drugs controlled under the 1965 Act, but also the amphetamines and similar drugs scheduled under the Drugs (Prevention of Misuse) Act, 1964.
My right hon. Friend hopes shortly to put his views before the various interests concerned. It is possible that, if additional controls are found to be desirable, he may wish at a later stage in the consideration of the Bill to propose the addition of some suitable provision for this purpose.
But, as I have indicated, there must first be consultation with the interests concerned, and I am not in a position to say more today.
To sum up, the Government believe that the changes in the organisation of treatment for addiction contemplated by the Bill are important and urgent. The changes will be made in full consultation with the medical profession. There is general agreement that some changes will involve a delicate matter of balance. We want to build on the experience of the past, not destroy it. We want also to retain the confidence of addicts.
No one doubts the vital importance to them of a smooth transition from one regime to another. The cost of failure would be a major expansion of illicit traffic, and of addiction, and the frustration of all hope of helping those who can no longer help themselves.
Much of my speech has inevitably been devoted to the machinery for dealing with doctors. If, as I believe, doctors will collaborate to make the new scheme effective, the tribunal may never have to meet.
482 It would be wrong to view the Bill as a Bill against doctors. Its aim is to improve help for addicts, and I hope that on that basis the House will unanimously give it a Second Reading.
§ 4.34 p.m.
§ Mr. W. F. Deedes (Ashford)
The House will be grateful to the right hon. Lady for the exposition that she has given on the Bill, and for much that she has said about drugs in general. For our part, we are glad to have this evidence that the Government now accept that we face a serious, and on the figures given by the right hon. Lady, perhaps a deteriorating situation. Further, we welcome the awareness which the right hon. Lady showed that addiction, with which the Bill deals, has its roots in the larger sphere of drug abuse. At this stage, I would add only one comment to what the right hon. Lady has said. The Government have a big sphere of responsibility here, but so have a great many other people. We shall not beat this with laws alone.
There are limits to what we can do here, and it is important to stress this. Many people outside the House have a grave responsibility for the young in this regard, and we must do all that we can to make them aware of it. With this Bill we embark on a new, uncharted and perhaps hazardous course of action, against the spread of drug addiction. In effect, and I do not think that the right hon. Lady will contradict this, a handful of doctors—in my belief not more than seven or eight—have compelled us to take this course.
As Lord Brain put it:
The activity of a very few doctors who have prescribed excessively for addicts.That is the reason for the Bill. Lord Brain told us in July, 1965, about this, and it will have taken us nearly two years to act on this warning. During this time, as the figures given by the right hon. Lady make plain, the situation has got a good deal worse. She admitted that the official figures were to be taken with reserve.
For 1966, the right hon. Lady gave us the figure of 1,139, and said that it was anyone's guess what the total may be. My own guess, backed by some information which others have, would be around 2,000. I do not think that that would be too far wide of the mark. But we simply do not 483 know. One must regret this delay, although I am fully aware of the reasons for it. I know that the negotiations with the medical profession have not been easy, and I accept, also, that in this baffling area there will never be a final or very satisfactory solution. Having chosen this course, we must now spare nothing to make sure that it works. If we fail, then we will be in very serious trouble.
May I add to the tributes paid by the right hon. Lady to the work which a great many people, professional and voluntary, have been doing in this area. They have been doing what they can while we have been deciding what we can do. I am not much troubled by the machinery laid down by this Bill. I appreciate the precautions which the right hon. Lady laid stress upon. In part, it is at variance with earlier advice that the Rolleston Committee and the first Brain Committee offered, but I accept that there has been a great deal of change since then. It is apparently what the doctors want, though I am bound to say that in my view they would have been wise to have retained more responsibility for their own discipline; but that is for them and not me.
The crux of the matter is this: in effect, we have decided to wean narcotic addicts off general practitioners and on to treatment centres. That means not only those who are now getting drugs from doctors, but an unknown, and I fear a considerable, number who are getting drugs not from doctors but from other addicts who have been getting excessive amounts.
The minority are to be treated and a majority, at least for a start, will be maintained. I want to say nothing to make this very difficult transition even more difficult, but we must know what we are doing. We have opted for a compromise, we have accepted, as the right hon. Lady said, the principal Brain recommendations save one.
Lord Brain urged powers for compulsory detention of addicts. That has been rejected, on balance, and I do not quarrel with that. I understand the dilemma, but we must realise the consequences. It means that those addicts who are unwilling to submit themselves for treatment must be maintained, not privately but publicly. The Government have no 484 option but to take part in a régime which, for many of the addicts, will be a hopeless régime. Some addicts can be stabilised, others for psychological and physical reasons cannot. Their need will grow, and if they do not accept treatment they will eventually be destroyed. That is a very serious state and it is not one that we should underrate, albeit we may accept the course that the Government feel that they must take.
I realised how serious a step this was when I read the other day part of the report of the President's Commission on Crime in the United States. It puts on record a statement by the American Medical Association. It is supported by the National Research Council of the National Academy of Sciences in these words:Ambulatory clinic plans (dispensing drugs to out-patient addicts through clinics established for that purpose) or any other form of ambulatory maintenance (giving stable doses to outpatient addicts) are also medically unsound on the basis of present knowledge".I am aware that not all doctors here or in the United States would agree with that judgment. None the less, that was the judgment of the A.M.A. in 1963, and it stands today in the United States.
However, we have elected to take this course, and I think that the next point which arises is this. The scale of this operation, considering the relatively few involved, will be very big. Do the Government realise just how big it will be? I know that these administrative arrangements involve detail, but, in my view, getting the details right is absolutely crucial to the success of the approach. I wish to touch for a moment or two on some of the details which I think are important.
I sense a disquieting gap between the Minister's estimate of what might be needed by way of money and skilled manpower and the estimate which I have had from doctors and psychiatrists who are already at grips with this problem. I must ask this question, to which the right hon. Lady made no reference; I expect that the right hon. Gentleman the Minister will refer to it later: what estimate has been made of the cost of these arrangements? The Bill refers to negligible expenditure on tribunals, should the need arise and fees, but it says nothing about the cost of the outpatient clinics or in-patient treatment.
485 From where will the money which is needed come? We asked the Minister of Health this question in an earlier debate, and he said that he did not think that the cost of treatment would be large in relation to the total cost of the hospital service. But it will be additional and, in my view, relatively substantial. If it is not added, the money will have to be found from existing resources. Which resources? I must ask what additional resources are being allocated.
It is not only a matter of money. Addicts are prodigal of skilled staff. A small unit dealing with nine addicts requires about three skilled people who, in other circumstances, would be sufficient for 60 patients. I hope that as many as possible of those already engaged in this work will be enabled to continue with it. But we shall obviously need even more, because we shall gather in addicts who so far have been nowhere near medical supervision or attention. Where is it proposed to establish the out-patient clinics? How many shall we have? I should be grateful if the right hon Gentleman would say how long they will be open, because this is very important from the staffing point of view.
This is talked of as a London problem, and so predominantly it is. But suppose that London accounts for two-thirds of the known and unknown addicts—say about 1,600. We cannot, alas, limit the facilities to London. The Bill covers the whole kingdom. It shuts one door everywhere, and wherever there are addicts another door must be opened. To provide sufficient centres and staff is absolutely crucial.
To put it bluntly, the new régime must appear to be an attractive proposition to the addicts. They must be drawn to it. Having had the opportunity of talking to some addicts who were undergoing treatment, I sense that there is a gap between the present régime and the régime which is in prospect. Unless the addicts can be induced to move from the present system—the system which the Bill closes—to the new system, we shall be in danger of creating one thing which we must avoid—an illicit market controlled by criminals.
I do not wish to dwell too heavily on this point, because it is easy to exaggerate, but it would be unwise of us to under- 486 rate it. As the Home Secretary knows, this is a very easy field for crime and very difficult for enforcement, because drug peddling is consensual. There are no complaining victims; there are only willing sellers and ready buyers. That is the deadly thing about it which makes it such an appalling subject for the criminal field. I do not want to exaggerate it, but it would be silly to ignore it.
Someone with great experience of this subject has communiciated with the Home Office. It is not an official document, so I can quote from it. He wrote:It would seem, on the face of it, to be quite likely that it"—he meant the Mafia—is watching the situation here with some interest and is probably alert to three primary considerations: the size of the pool of current addicts, its rate of increase, and the proportion of addicts who are or will be unable to get the heroin they need. When all three, taken in conjunction, reach a critical level the trade can be put on a proper footing".Thus, the safe transition from private medicine to public clients becomes very important.
I know that there will have to be contrived a very delicate balance between offering every encouragement to the addict to accept treatment and appearing to trap him into treatment. As the Minister knows, we are dealing with a very wary and suspicious group. Their approach to the out-patients' clinics will be the approach of mice to baited traps. How will their need be assessed? This is a very important detail.
For proper assessment, about two days in-patient treatment is desirable. But not many will readily submit to it. There will be a natural temptation to cut down on over-prescribing at clinics. Yet, in my view, it is imperative that clinics continue to over-prescribe to a degree.
The life of the addict is very complex. It costs him about £10 a week to live. He spends about £3 on the doctor and £7 on the chemist, according to my information. For these sums he relies largely on what the Army once called the "unexpired portion of the day's ration" which he can sell, at current prices, for £1 a grain to those who are not going to doctors, and he can sell some to addicts going to doctors but who are not getting enough.
487 It is true that under the Bill all will get drugs free. The addict's staple companion will have to be notified, and he will get them free. The companion who is not yet perhaps under medical care must be notified. He must join the system, or he will enter illicit channels. But, even so, it is my view that addicts will not readily accept the bare minimum.
In a recent speech, the Home Secretary talked, quite rightly, of clinicswhere prescribing of drugs will be most strictly controlled".That is all right as far as it goes. But I must add that it is exactly what the addict fears. Unless he gets a margin, there is a danger that he will go elsewhere. We must face the fact that some addicts will be able to work and that some will not. To those who cannot work we shall have to give National Assistance. Not everyone will like this. There could be a public outcry. But it it is part of the price which we must pay for making the system succeed, and I would support it all the way.
An addict has made a suggestion to me which I pass on to the Minister of Health because I think that it is a good one. He said that to gain the confidence of the addict, which is so important, the Bill's vesting day might be postponed for a short time and addicts allowed to draw prescriptions alternatively from their present doctor and the prospective clinic until they are familiar with the clinic and are assured that they will get what they hoped to get. So important is this element of confidence that I put forward the suggestion as being psychologically sound.
I come now to in-patients, of whose number we have no clear idea. I understand that it takes about five or six months to treat in-patients, and that I know can be done in the mental hospitals. But what arrangements will there be for the follow-up? Relapses are all too frequent. Is the discharged patient to be supervised on discharge, and, if so, by whom? Will there be anything like Nalline centres? Will there be hostels where a helping hand can be given?
We shall have to divide the in-patients into two categories, those regarded as 488 temporary civil commitments and those charged with criminal offences. What is to be done about the second category? Shall we, as in America, offer an addict offender the choice of going to trial or being committed to treatment with the new system which is coming in? If that is to happen, how long would the commitment be and where would it be? When the offender is discharged, what supervision will there be under the system? Who will check up on him?
I am aware that some prisons now have psychiatric wings where treatment can given, but that is rather too limited, I think. The real need for treatment is not in prison, but on remand. It is in the first stages of a charge that the offender who is an addict undergoes the pangs of what is called "cold turkey". Once he has suffered those, it is extremely difficult to get him to accept treatment in any circumstances. That is something which wants to be looked at.
Another small but very different category is the heroin addict who is suffering dangerous self-neglect and must be rescued. This addict is not uncommon. One medical officer outside London has successfully invoked Section 47 proceedings under the National Assistance Act as revised in 1951. Is that sound? Can we rely on that method of rescuing addicts who are found in extremis and who, unless they are rescued, will die where they are? If not, ought we to consider incorporating something in the Bill?
That seems to be the nub of the problem, but there are one or two other considerations arising from the Bill, one of which the right hon. Lady referred to when she mentioned the problem of security arrangements. I know that we should welcome any suggestions which came from the Home Secretary for tightening up on manufacturers, wholesalers and chemists who handle not only dangerous drugs but barbiturates and amphetamines. I see evidence that the manufacturers are trying to improve security, but some wholesalers are still flagrantly careless, and so are many chemists. The all too frequent and successful raids indicate where our defences are weakest. If the right hon. Gentleman needs our help here, he can be assured of our support.
I must question for a moment our machinery for this. I am sure that it is 489 right for the Home Secretary, as he has, to take charge of the Bill, but, in the long run, does it make sense to add the problems which will arise from this Bill and other matters which now call for close and undivided attention to the administration of his own and two or three other very busy Departments?
Ought we to have something akin to the Bureau of Narcotics or Bureau of Dangerous Drugs, with a director answerable to the Home Secretary, but outside the immediate orbit of the Home Office? We ought to consider that. At least one responsibility of such a body would be the preparation of proper information for dissemination to the public.
I have raised with the Home Secretary already the question of police powers. There is a short point here. The police can arrest without a warrant, but they cannot search without a warrant and, where drugs are involved, this seems to be a very important thing to be able to do. Where they have reason to suspect the carrying of firearms, I understand that they can search without a warrant. There is a case for offering them similar powers in respect of dangerous drugs, because the delay in getting a warrant, particularly at a weekend, can sometimes be decisive.
The right hon. Lady said very little about "soft" drugs, although she admitted that it is related to the subject under consideration. It is accepted that it is not just a social but a medical problem and, in relation to the Bill, we must accept that we have adolescents who may not only become addicted to these drugs, but who can become dependent on barbiturates and amphetamines. Where do they come in these arrangements? Really, we need field workers to identify them, and units well away from the heroin units where they can be treated. Is there a possibility of adding some such machinery to that which is to operate under the Bill?
We shall make very little headway until we can persuade the medical profession to reappraise the wholesale prescribing of barbiturates and amphetamines not in tens of thousands or even hundreds of thousands, but in tens of millions. I must say that it makes no sense for the police to go round raiding and stripping young people at parties to find drugs, some of which their elders 490 treat as a staple diet. The posture against the young becomes morally untenable.
That brings me to the difficult matter of cannabis, or marijuana. It is being strongly urged that enforcement under this Bill is weakened by the inclusion of marijuana or cannabis on the list of dangerous drugs. A great many people besides "pop" singers believe that we should be in a stronger position over heroin, which is deadly, if we ceased to put in the same category cannabis, which is not. Speaking for myself, perhaps the right answer is that we cannot possibly relax the law on cannabis until we know much more about its effects and side-effects. For that reason, it is an urgent candidate for the kind of research which I understand is to be set up concurrently with this Bill.
Superficially, cannabis, or marijuana, appears less dangerous than L.S.D. which, in certain circumstances, indubitably can induce madness. But we do not know the facts, and in view of the controversy which is running and the relationship to the Bill, an urgent inquiry is needed. There is a mass of material on the subject, and we should devise a plan of research.
Personally, I go some way with the comment made by the medical correspondent of The Times earlier this week. On the argument about cannabis, he observed:How to sort out this problem—a complex of morals, law, and medicine—is going to be a difficult task, and it may well be that the final answer will involve a drastic alteration in the present permissive moral outlook of the community—and particularly of parents.There is a lot in that, and nothing in the Bill or in the regulations which the Home Secretary is to prescribe should lead us to think otherwise.
Nothing in the Bill will safeguard parents who get woken up by policemen and told to collect their children, supposed to be staying with friends, from a sleazy club or clip joint. The Bill alone will not reclaim this alarming sub-culture which has developed in London and other big cities. Hon. Members besides myself will have seen the fringes of it and the young people who have rejected their homes or been rejected by their homes, living rootless, jobless existences in the twilight of what we ludicrously call "swinging London".
491 That is one hard core of the problem. There are many strands. There is the sub-culture, the anti-authoritarian spirit which is abroad among some, and there is the mood of rejection among a minority of the young. In my view, they make it a particularly difficult field of activity for legislators.
As long as we are careful to avoid exaggerating what we can do with a Bill like this, it does not matter. The Bill, for all its good intentions, really does no more than scratch the surface of a very complex human and social situation, and we should be wise to stress our limitations and how much more is demanded of others, including parents and teachers, some of whom tend to take an uncommitted and rather neutral attitude.
When I began to take an interest in this problem I formed the view that it was a symptom of our easy-going society. Drugs, it seemed, were the ultimate disproof that permissiveness paid off. I have come to see this as only partly true. Fundamentally, this curse springs from something else. It springs from inadequacy, from the fact that in the modern industrial society a great many people, starting with the school drop-outs, find themselves below, not the poverty line, but what I term the adequacy line. This touches a great many in our society today. They may be housewives, they may be grown men, but mostly they are adolescents, and they suffer this sense, to which a modern industrial society gives rise—and not only here—of inadequacy.
I think that that is partly what drugs are about, and partly what this Bill is about. The cure will be a very long and difficult quest. The Bill—and I do not say this offensively—is a small pill for a big illness, and to find the remedy for that illness will, I think, test us all very severely.
§ 5.1 p.m.
§ Dr. A. D. D. Broughton (Batley and Morley)
We have been informed that it is now the policy of the Government to have drug addicts treated at special centres, and it will be interesting to hear in due course from my right hon. Friend the Minister of Health where and in what manner he intends setting up these centres. I expect that several of them will be needed for London, and one in 492 each of the large cities in the country, and it is my hope that these centres will be at teaching hospitals, but these are details which I hope the House may be able to discuss on a future occasion after we have had the opportunity of hearing the Minister's proposals for these centres.
I merely say now that I am very glad to know that proper facilities are to be provided for the pathetic cases of drug addicts, and I should like to underline a point made by the right hon. Member for Ashford (Mr. Deedes), and that is the importance of these centres being made attractive to drug addicts. After all, the centres will not serve a very useful purpose if the drug addicts are not willing to make use of them.
The Bill demands two changes in medical practice. As we have been reminded this afternoon, these changes follow the recommendations of the Inter-Departmental Committee on Drug Addiction which sat under the distinguished chairmanship of the late Lord Brain.
The first of these changes contained in the Bill is to require notification of addicts by medical practitioners. The second is to prohibit medical practitioners, except under licence, from providing addicts with specified drugs. As a general rule I am strongly opposed to medical practitioners having to fill in more forms, as will be required in the notification of drug addicts, and as a general rule, also, I am strongly opposed to restrictions being placed on medical practitioners in the treatment of their patients, but in these instances when we are dealing with this problem of drug addiction I accept both these changes as being necessary.
The figures which have been given to us showing the increase in drug addiction are alarming, and no responsible Government could possibly stand by idly watching this menace grow. I have heard no objection from any of my medical colleagues, and I am sure that the medical profession as a whole will accept the Government's proposals as inevitable and essential.
Whether these measures will prevent the further spread of drug addiction remains to be seen. I hope that they will achieve their object, but if they do not, then maybe the Government will have to take further action, and certainly all of us will have 493 to give the matter a great deal more thought.
It is clear that the Bill will not prevent a doctor from being able to prescribe dangerous drugs in the usual small quantities which are used in the treatment of accidents and illness. It will prohibit the supply by him only of dangerous drugs to addicts—other than by medical practioners under licence, presumably at the special centres—for the treatment of drug addiction.
I believe that that restriction has become necessary, bearing in mind that we want to stop the spread of addiction, and I would like by way of illustration to quote a case which came my way professionally very recently. I mention it just as an example of what is going on. The patient is a young man in his early twenties. The background history is that of an unhappy childhood. The father died when the patient was a small boy, and he has received no affection from his stepfather. He grew up into an unstable, somewhat irresponsible youth.
A few years ago he started to smoke "reefers". Twelve months or so later he took "pep pills", and 18 months ago he proceeded to take the "hard stuff". He is now a heroin addict. He told me that he could obtain heroin without difficulty. He knows a doctor in the East End of London who is sympathetic towards addicts, and who gives him a prescription for the amount that he requires. He said that when the doctor asks him how much he requires he always tells him a quantity which repesents twice his needs. He visits the doctor as a private patient, and he pays 30s. for the brief consultation and the prescription. He then takes the prescription to a chemist who hands him the heroin and charges him 30s. as a dispensing fee. Thus, it costs him £3 to obtain his supply of heroin. Half the supply satisfies him for a week, and he sells the other half in the West End for £3, thus obtaining the money for the next week's supply.
Apparently he has no difficulty in selling his surplus, but, having seen this patient and realising the extent of his addiction, I am sure that if he encountered difficulty in disposing of his surplus he would attempt to create a market by inducing others to take the drug, and so would make more drug addicts. As this is actually happening, it is essential that drug 494 addicts should be given no more than their necessary requiremens, and I believe that the necessary control can be exercised only by the measures contained in the Bill, namely, by a central authority knowing who are addicts, by addicts being treated at special centres, and by medical practitioners, apart from those under special licence, being prohibited from providing dangerous drugs for addicts. I believe that it is imperative that these steps be taken to try to prevent a further increase in drug adiction.
I may have seen more drug addicts than other hon. Members. The cases are pathetic and pitiful. One sees in them a physical, mental and moral deterioration. they lose interest in their work; they lose self-respect and respect for others, becoming untidy, slovenly and neglectful. The process of deterioration can go on to a disintegration of the personality. These people become notorious liars. They do not differentiate between truth and untruth. The answers they give to questions and the statements they make are related to what they consider to be best in their own interests, regardless of truth. They are unreliable in speech and action.
Many who fall victim are emotionally unstable and inadequate types of personality. These characteristics of emotional instability and inadequacy are not uncommon among the young, and it is youth in particular which needs protection against these terrible dangers. The measures contained in the Bill are directed towards adequate treatment for addicts and the protection of others by attempting to remove at least one source of supply of the drugs. I certainly give the Bill my support.
§ 5.11 p.m.
§ Sir John Vaughan-Morgan (Reigate)
Not for the first time I rise to speak with some diffidence in that I follow the hon. Member for Batley and Morley (Dr. Broughton), who is a doctor and a psychiatrist, and, therefore, speaks with expertise. He in turn followed my right hon. Friend the Member for Ashford (Mr. Deedes), who, in an outstandingly humane speech, proved that he has made himself an expert—in the best sense of the word—on this squalid subject. I shall shortly explain why I have become interested in it.
First, I want to pay my personal tribute to Lord Brain, whom I knew for many 495 years, both in his capacity as a neurologist—when a member of my family was his patient—and also when I was at the Ministry of Health. I know what an outstanding personality he was and what an immense strength he has been in terms of the wise advice that he has given to Governments at different times.
I only have one painful memory. I was at the Ministry of Health and he was president of one of the royal colleges, and we were engaged in one of those almost endemic battles with the medical profession on the subject of pay. I found myself confronted with a Lord Brain who was white in the face with anger across the table in the Ministry. But he never let that interfere with our relations outside.
The Bill takes new and exceptional powers to deal with a new and exceptional situation. It is concerned with a problem that is baffling to the experts; indeed, the experts themselves are really ignorant. I agree with the hon. Member for Batley and Morley that these exceptional powers are thoroughly justified. On paper, they look frightening, but we need not be too squeamish about them. Nevertheless we must realise that they represent a large infringement upon the liberty of doctors to prescribe.
The tragedy is that the permissive policy of which we have been so proud and which allowed doctors complete freedom, has broken down. Throughout its duration it has undoubtedly frustrated the organisation of a large-scale illegal supply by racketeers. The system works well, and has broken down, apparently, only because of a small minority which has abused it.
In his Report, Lord Brain referred to there being six doctors who over-prescribed. As I came to the subject fairly recently, I have read the Report only in the last few days, and in it there is this incredible sentence:Thus, we were informed that in 1962 one doctor alone prescribed almost 600,000 tablets of heroin for addicts. The same doctor on one occasion prescribed 900 tablets of heroin for one addict and three days later prescribed for the same patient another 600 tablets 'to replace pills lost in an accident'".One simply cannot understand the mentality of a doctor who would be so criminally lax or so laxly criminal, what- 496 ever it is. That is why we have to adopt this new system.
The burden of operating the system will fall on the hospital service and, in particular, on certain designated teaching hospitals in the London area. I understand that on present plans three or four teaching hospitals will take part. Perhaps the right hon. Gentleman will correct me if that is not the case. As the chairman of a teaching hospital, I know that the Minister of Health is already aware of the fact that all those involved are only too willing to co-operate at all stages. The only regret that some of us feel is that the discussions which have taken place recently have been rather hurried. It would have been better if the discussions had been started a year or so ago. I do not say that in a carping or critical way.
As my right hon. Friend said, this will be a very expensive business. Quite apart from the vast need for research into the subject, it will mean an expensive form of treatment for a very few patients. The nub of the whole matter will lie in the financing of the treatment. As a layman I want to ask a question which I hope the Minister will answer at the end of the debate. As I understand, notification of addicts implies a central register, and I understand that that register will be kept by the Home Office. I want to put in a plea that it would be preferable for the Ministry of Health to have responsibility. The Minister of State said that we had always treated the addict as a sick person and not as a criminal. I think that that is right. To stress that side of the matter it might, therefore, he wise to allow the machinery to be operated by the Ministry of Health rather than by the Home Office, which has other associations.
There will have to be constant consultation between doctors and hospitals and between Government Departments. Hospitals frequently curse the Ministry of Health, but they do know their way about the Elephant and Castle better than Whitehall and would prefer the devil they know to the devil they do not. This could be justified, as it is a public health problem.
The nub is the financing. It is gossip that the Ministry of Health has not been successful in wheedling any extra funds from the Treasury. If so, I am sure that 497 the right hon. Gentleman fought a very good fight in the cause. But I regret it. We will be told that this extra item will have to be lumped in with the other National Health Service expenditure. No doubt this will not seem very much when compared to the total of £800 million, but it is outside the normal service to patients of a general or teaching hospital.
It will have to be given top priority, which means that something else at the bottom of the priority list will have to suffer. Every hospital has a long list of appointments to be filed in the course of the normal development of its normal district services. Some of these appointments will have to be deferred because of these new commitments. It may be that, say, only two registrars and four or five nurses will be needed, but those extra appointments will mean that other departments which have been waiting for years to expand their services will have to wait even longer.
Some hospitals—this is the fault of the system—have bitter experience of having been given a special job by the Ministry and a special allocation for one year only to find that the next year the allocation went on their normal maintenance budget. They feel that they have not enough money. I plead with the Minister to see that those who will be asked to act as his agents in this matter will have a special grant separate from their normal maintenance budget and that it will be kept separate for many years.
The right hon. Lady rightly pointed out that everything in the Bill and in the mechanism to be set up is provisional and is bound to change and develop. For that reason alone, those who are the willing agents of the Minister and anxious to co-operate should have special financial treatment. I have spoken on a narrow point, but I cannot help feeling that it is also important.
§ 5.19 p.m.
§ Mr. Arthur Blenkinsop (South Shields)
I recall with some sadness that, when I visited the United States some years ago and discussed some of the problems of our health service and was asked about the provision which we made for drug addicts and alcoholics, I stated the truth in answering that it was not a particular problem here. We must 498 recognise that this problem has built up with remarkable speed.
I pay tribute to the valuable and thoughtful speech of the right hon. Member for Ashford (Mr. Deedes). All of us welcomed it very much. We are living in a society where abuse of alcohol is accepted more or less—rightly or wrongly—and in which nearly every household has a plethora of drugs. It is worrying that in many ways this is part of our society's atmosphere, in which parents are commonly prescribed drugs for relatively minor complaints. I share the right hon. Gentleman's feeling that it is a little hard to vent our anger and bitterness wholly upon the young when they are living in such a society. We must ensure that some of our anger is directed elsewhere, at the problems of this society.
It has been said that there are grave dangers of an increased black market should the new system of treatment centres and special out-patient facilities not attract the known addicts and those about whom we know little. I would therefore reinforce what has been said about the vital importance of ensuring that adequate facilities are available and adequately financed. This is very expensive in money and manpower.
It is not only a problem which affects the capital city, but in some ways it is even more difficult to set up and man centres in areas in which the number of cases is relatively small. Here there will be even less willingness to make the necessary provision for what initially may be only a few cases. Yet it is vital that provision should be made there as well as in London, where we know the acuteness of the situation.
The other danger which we have all realised arises from the Press and television publicity of this issue. I do not blame those concerned, because this is a public issue which should naturally be discussed. What is dangerous is that a generalised condemnation of all drugs gives the idea that the danger is of the same level for all. Although this is demonstrably untrue, those who listen to this and are in danger of becoming addicted and are already taking one of the "soft" drugs may think that therefore the information about the "hard" drugs is equally inaccurate. We should give 499 special attention to this feaure of the problem.
That simply means that there is an overwhelming need for more reliable information about the effects of the great variety of "soft" drugs as well as of the "hard" drugs. Considering for how long the Americans have been faced with this problem, it is amazing that we have so little reliable information about this subject. We must obtain completely accurate information if we are to move forward in the right way.
One of the dangers of marijuana is that, while it is not an addictive drug, it can easily lead to its takers going on to "hard" drugs, and what can follow from that is really dangerous. We do not know how many people who take marijuana later move on to taking "hard" drugs. We know quite a lot about how many of those who are addicted to heroin started by taking various forms of "soft" drugs, but we do not know the proportion of those who take "soft" drugs who later go on to "hard" drugs, and why. In other words, we must get accurate information about this and other matters if we are to frame the right social action.
The right hon. Member for Ashford referred to L.S.D. and he was right to say that we are appalled by some of the consequences resulting from the increased use of this drug. Many tragedies, including suicides, have occurred, but we have very little information about the number of people taking L.S.D. Until we get better information we will not be able to frame effective action, either legislative or social.
I need not urge my right hon. Friend to realise the immense importance of social work in this matter and I agree with what has been said about the small contribution that legislation can make in some respects. On the other hand, I am aware of some of the wonderful work that is being done by social welfare workers and I hope that, in the setting up and running of the new centres, we will ensure not only that adequate medical staff is available but that adequate welfare staff is also available to do the necessary follow-up work. I hope that, at the earliest possible opportunity, the advice of those who have been devoting 500 themselves so selflessly to this work will be sought.
I accept, as we must, the urgent necessity for the Bill and hope that it will be passed rapidly. I agree, however, that we are moving into a sphere about which we know little and about which we may need to take further steps.
§ 5.34 p.m.
§ Dr. M. P. Winstanley (Cheadle)
I am conscious of the fact that in addressing the House today I am addressing hon. Members who have great knowledge of this subject, professionally, politically and socially. I, too, can claim to have a fair knowledge of the subject. I have had the responsibility of dealing professionally with drug addicts and I have also had the even more distressing responsibility of dealing professionally with the wives, husbands and parents of drug addicts.
It would be impossible, unnecessary and unwise for me to attempt to give my views on every facet of this important issue. I am sure that I will be best serving the interests of the House if I concentrate on some of the points which may not arise during the debate. In concentrating on these points, I will tend to stress the dangers that lie ahead with the passage of the Bill, although I do not want it to be thought that I do not support the Measure. I wholly support it, but certain dangers and warnings should be mentioned because it is vitally important that the Department should be aware of them.
In the serious and alarming situation which faces us we have a dilemma for the politicians, the general public, and particularly the doctors which is well nigh insoluble. Many hon. Members have referred to the undoubted fact that if one cuts off the source of supply to a drug addict, that addict is immediately forced to create other addicts to find the wherewithal with which to obtain further supplies. This is well known and is the pattern that has been noted in the United States, where extremely restrictive legislation exists and where there is a flourishing black market.
Once an addict's supplies have been cut off, he is under pressure—having no other source of supply—to go to the black market. But first he must obtain the funds with which to buy his black 501 market supplies, and to obtain these he is forced to create other addicts. In other words, if we take the wrong step now—something which we could easily do; a number of pitfalls lie ahead—we will be in danger of causing an explosion and thereby escalating the problem.
The dilemma of a doctor who is faced with an addict, a group of addicts or a society in which there is a percentage of addicts is this. If he is given compulsory powers to take a patient into some sort of custody, however humanely and compassionately that is done, he will cure that addict. However, he knows that if he gets compulsory powers which are effective, he is then creating a situation in which other addicts will be created. The alternative is to allow the doctor to supply the drugs. But in that case one is saying to the consultant psychiatrist or doctor, "You may give these drugs, but you may kill these addicts". One is thereby killing them to benefit the community as a whole and to prevent the problem from escalating.
It should be emphasised that the period of delay which has occurred in bringing forward this legislation has been occupied with discussions with the medical profession. The delay has not arisen because the profession has had any desire to protect its integrity, to preserve its autonomy or to protect its rights. The delay has been occasioned by the simple fact that the members of my profession who have been conducting negotiations with the Government have for a long time been undecided about the best steps to take—not in the interests of the B.M.A. or the profession, but of the patient. It is difficult to decide how rapidly we can proceed with compulsion or to what extent we should allow a permissive scheme to operate. I therefore do not join with those who have criticised the Government for having taken time to introduce this legislation, for it is right that they should have given careful consideration to the timing of these steps.
Having said that the medical profession is still undecided about the best route to follow in the interests of the patient, I must also say quite clearly that it would be difficult to find a doctor who is opposed to the kind of measures here envisaged. There is much talk about the profession's jealousy of its freedom to prescribe, and so on, but I have no personal knowledge 502 of any doctors who feel that this legislation will clip their wings or deprive them of the freedom they have hitherto enjoyed.
I have served on a number of statutory bodies representing general practitioners—on one committee representing 3,000 of them—and I have not heard a solitary expression of opinion that this Bill constitutes some kind of attack on their freedom which must be resisted. Indeed, had doctors felt that way they would probably have asked me to resist on their behalf. They have not done so. They are wholly on the side of the Ministry in this matter, and are quite willing to see such steps as this taken. Their only anxiety and doubt is as to what measures are likely to be the most effective and attended by the least danger.
I want to point to a number of possible dangers and, with all humility, to deliver a few warnings. It is absolutely essential that whatever provisions are made—and here I refer to the many steps envisaged in the Bill and also to the parallel steps that are being taken by the Minister of Health for the provision of clinics, treatment centres, and so on—they should be implemented with the utmost humanity, compassion and care. Any tendency on the part of the new treatment centres to become institutionalised in the worst sense, to become formal and impersonal, will defeat the object we all have in mind, and will result in the problem going underground, though only temporarily.
In the temporary period when we had compulsory measures to deal with the problem of venereal disease I was in charge of a hospital board that was treating patients, getting information about contacts, sources of infection, and so on. Hon. Members will remember that special legislation was provided when there was a serious outbreak of this disease during the war. I then had experience of one or two establishments. In one, the scheme worked perfectly efficiently because the work was conducted with humanity and compassion. The patients did not feel that, in some way, they were venturing into a place where they would lose their personal rights. They had no fears of that. I found other establishments where, though the rules were the same, the atmosphere was different. As a result, one 503 either did not get the patients in the first place in order to treat them, or they tended to disappear.
It is absolutely crucial that restrictive measures should not precede the availability of these other resources. If one closes down supply in one area without in advance making sure that the supply is opened up in another, although with all proper controls, supervision and so on, one is in precisely the same peril as in cutting off supplies.
Another point is the undoubted clinical importance in the treatment of drug addiction of preserving a close personal relationship between the physician and the patient. I know that the alleged close personal relationship which is supposed to exist between patient and doctor is something that today is perhaps getting into some disrepute. Indeed, to read some of the things the doctors say of their patients and some of the things the patients say of their doctors, one might come to the conclusion that the close personal relationship has descended into one of complete and undisguised hostility. That may be true in some cases, but if we are to have any success in treatment of drug addiction it is essential that some relationship should be preserved between doctor and patient—
§ Mrs. Gwyneth Dunwoody (Exeter)
Does not the hon. Gentleman feel that the very setting-up of these specialised units will in itself provide this very special relationship? He is stressing very much the aspects that concern us, quite rightly, about the doctor-patient relationship, but is perhaps not stressing adequately just how exhausting this relationship can be. I believe that at the present moment the general practitioner relationship to the addict is far more inadequate than the specialised relationship that will exist between the psychiatrist, the consultant psychiatrist and the patient in the specialised unit.
§ Dr. Winstanley
I am grateful to the hon. Lady for her intervention. I, too, have been exhausted in that way. I realise that the special relationship does not necessarily exist in the general practitioner's sphere, and it need not exist in the clinics unless we see that it does exist. However, as I have said, I am entirely 504 in favour of this Bill, and am now merely stressing a number of points that I believe to be of crucial importance if the establishments are to work. It would be possible for us to establish centres that were understaffed and overworked, and in which there were rapid changes of personnel so that the same doctor did not remain for very long. That would be totally destructive.
The Minister must see that the arrangements are such as to provide continuity of care and treatment, so that the type of relationship of which I speak is preserved. That is important, just as it is important in alcoholism, and just as it is important in psycho-neurosis also, and, as we have with us the Minister of State, Home Office, I would add just as it is important in the probation service. One cannot have a functionary whose identity changes from day to day. We want someone who can win the confidence of the patient—and we must regard the drug addict as a patient rather than as a criminal.
It is important that a fair degree of discretion should be left to the general practitioner in arriving at a proper professional decision on what does or does not constitute an addict. That will apply if the range of drugs is increased as is the obvious intention. The right hon. Member for Ashford, to whose speech I listened with very great interest, and which I entirely commend, rather emphasised the general question of people's reliance on phenobarbitone, sedative drugs, tranquillisers, and the like. This is a problem of course, but we would be in a most desperate situation if the individual general practitioner started notifying as addicts certain people who find that they can continue in life reasonably tolerably with assistance, whereas they break down without it.
Let us not forget that many of these drugs about which the House is now very rightly alarmed are of immense benefit to medicine, to doctors and to their patients. It is true that drugs have dangers. One will not get a drug with powerful effects without having a drug with dangers. If we were to throw away every drug that had any possible danger we would finish with no valuable drugs at all. If we said that we would never use a new drug unless it was found to be safe, we would never use new drugs at all. Some of the 505 drugs that have had the most striking effect in changing our mortality and morbidity statistics, and have changed the whole picture for many people by giving them life instead of no life, are dangerous drugs, and do certain people harm.
Some of these drugs are perhaps addictive. We know about the new anti-depressive drugs and their effects, but it would be unwise to say that they are dangerous things and that we would be better without them altogether. Certainly let us look at the dangers and provide against them, but we would be unwise if we tended to try to get rid of a drug merely because from time to time it has a particular danger of this kind.
As a number of hon. Members have said, we must undertake more and more research into this whole problem. I should like research to be particularly concentrated on the question of determining as far as possible who in the community happens to be at risk. It is a great mistake to run away with the idea that addictive drugs are something hovering in the air waiting to alight on someone and that that person is doomed. This is not so. I have had experience, as no doubt many doctors have, of people who have taken addictive drugs for very good reasons and they have been able to give them up without any difficulty. I have known others who have taken two or three doses and have been in an intolerable state because of a craving which only after a long period have they overcome.
The danger of drug addiction varies enormously from person to person, from adult to adult and child to child. We do not know anything like enough about who is at risk and who is not. We want to know more about why this problem has spread so much among young people whereas formerly it was very much less prevalent among the young than among adults. We want to know the relative importance of hereditary factors. As a politician I like to regard environmental factors as well-nigh crucial in everything. One is inclined to think that one could put society to rights always by adjusting the environment.
That is a happy feeling because it gives hope for the future, but there is more and more evidence accumulating to show that there are very powerful hereditary and genetic factors in this matter of which 506 we should have proper notice. Recently, as the Home Secretary is clearly aware, there have been studies in prisons of chromosome abnormalities. These have an important bearing on who has tendencies to be a criminal. We may not be able to solve the problem solely by dealing with environment. We have to find who needs watching and special care in the early formative years and in the very vital and crucial period of adolescence.
I hope that we can think about these things and about research. We cannot dismiss the problem merely by blaming parents. This we tend to do in regard to the young and we think that all that is needed is to put right home life. This is not sufficient. I have found young people living in perfectly well adjusted families and who have had every opportunity in life who yet have become addicts, while others living in conditions which one would expect to produce an addict have not become addicts.
This is a growing problem which changes in society. In a sense it is a melancholy fact of medical history that as we progress and get rid of many of the old diseases—we are to be congratulated on the fact that malnutrition and social diseases due to the absence of plumbing, such as plague, rickets and that kind of thing, have gone—new diseases arise to take their place. This problem in a sense is one of the new diseases. At the top of the list of new diseases there is a whole host of psychological and psycho-neurotic conditions which seem to stem almost entirely from our way of life and from certain hereditary trends in the community, and these have to be looked at very carefully.
This Bill deals, and deals quite effectively, with some of the symptoms of the disease, but that is all it does. It is welcome for all that and I support it fully, but I hope that when it finally arrives on the Statute Book, when its various provisions are implemented and parallel provisions made by the Minister of Health are implemented, we shall turn our attention speedily to getting down to discovering, curing and eradicating this underlying disease.
§ 5.55 p.m.
§ Mrs. Gwyneth Dunwoody (Exeter)
I had not intended to join in this debate, but it is too much to expect any woman to sit here all afternoon and to listen 507 to the gentlemen without getting her oar in. I do not intend to detain the House for long, but I am concerned because I think it right to stress that, whilst we are all very much in agreement with the provisions of the Bill, this is an opportunity which we should take to stress very much the wider problem of drug addiction.
I always feel that drug addicts are not so much immoral as ammoral. They are extremely difficult for the general practitioner to deal with. This is why in the past there have been some cases—fortunately a minority—in which members of the medical profession have found it much simpler to pass on an addict to be dealt with by someone else, because the addict brings social problems. He is prepared to lie and to make it difficult for the doctor to find out when he is telling the truth and that he is not prepared to go to any lengths to get supplies of drugs.
This is part of the problem, but we should stress the aspects with which we can deal and the new forms of preventive medicine we have to deal with the problem. We must know which of our young people need drugs and how they can be helped.
In a decade it has become fashionable to accept this support. We still regard a minor form of alcoholism as socially acceptable. Many people start the day with an odd drink and do not regard it as at all odd, but when we get to the point at which we can understand that it is the person who starts with a small support and then goes on to need larger and larger support and when we can tell why people need this kind of stimuli we shall have gone a long way towards recognising the difficulty of the problem.
Only on one occasion have I had to take amphetamines. That was when I was acting on the stage in a play by Brecht and I had to lug a great cart around the stage. I dunned my husband for a small amount of amphetamines in order to keep me going. I was absolutely horrified at the effect which they had on me. They made me completely invincible. After quite a small dose I firmly believed that I could do whatever I liked. Thinking back I shudder to think what would have happened had I been in charge of a car.
508 I was convinced that my judgment was superior to that of everybody else and that I could make no mistakes. These are not ideal circumstances for an actor, but at least there is no danger to anything except one's own reputation. I was struck by the fact that it was possible for somebody easily to take a socially acceptable drug and react in a startling fashion. There is far too much ease of acceptance. We turn to the amphetamines to help us with slimming and other problems. We do not always realise exactly what we are letting ourselves in for.
I hope that more money will be forthcoming for treatment centres and trained social workers. I hope that my right hon. Friend the Minister will be able to tell us that these centres will not be mere poor cousins of existing National Health centres, that they will not merely treat people already addicted, but that they will provide support for people in the long and difficult period after they return to ordinary life. The difficulty is not only that someone who has been addicted might not want to be treated. The difficulty is that, even after he has received treatment, he will return to the circumstances which made him want drugs for support in the first place.
We are still not taking the right attitude towards the increasing number of drug addicts. I find it dreadful to be told by a mother, "My child is such a nice child and so easily led. I now discover that she has been brought up in court on a drugs charge. My husband and I had no knowledge of what was happening to her or of the sort of life she was leading. We do not know what to do or where to turn to". Such things can easily happen in modern times and we all have a responsibility to ensure that at that point—or preferably even earlier—trained psychiatric advice and medical assistance will be available to help such people.
Generally, I very much welcome all the provisions of the Bill. However, I hope that it will merely be a small step in the right direction and that we shall go on to tackle many more of the problems connected with the treatment of addicts. I hope that the House will also say today that we are all concerned in this problem and that it is no use lecturing others. Morals cannot be legislated for. Personalities cannot be legislated for. We must 509 legislate to such effect as to remove the opportunity for any criminal section of the community to look for an easy, ready market, make enormous profits, and ruin the lives of many young people in the process.
§ 6.3 p.m.
§ Mr. Bernard Braine (Essex, South-East)
Like all other hon. Members who have spoken, I welcome the Bill. I have no quarrel with any of its provisions. The arrangements seem to be eminently fair to the medical profession, and I was glad that the Minister of State said that the Government would be ready to consider any suggestion for the improvement of its provisions, especially the Schedule. I hope that the Bill secures a swift passage.
It is understandable that there may have been impatience about the delay in bringing forward the Bill. The Brain Report was published over 16 months ago. Since then we have all become aware that the problem which the Brain Committee sought to remedy has worsened and become more urgent. If, however, the delay has resulted in the responsible Ministers carrying through their negotiations with interested parties more successfully and arriving at the right decision, it would be wrong to indulge in any carping criticism.
However, not a day passes without the Press reporting a police raid on a coffee bar or a sleazy club frequented by teenagers, or arrests for possession, or stories about pop stars and drugs. "Pop" stars even write to The Times on this subject now.
On this matter, I do not agree with the hon. Member for South Shields (Mr. Blenkinsop). I think that such publicity, though it is about an extremely unpleasant subject, is to be welcomed, if there is to be a proper public awareness of what is happening and what could happen.
My right hon. Friend the Member for Ashford (Mr. Deedes) riveted the attention of the House. His humane and knowledgeable approach to this subject is well known. I agree with him that there are others outside the House who have a responsibility in this matter, notably teachers and, above all, parents.
All this publicity about drug abuse may be evidence of greater vigilance on the part of the authorities. I hope that it is.
§ Dr. Winstanley
I agree that publicity is necessary so that the problem can be made known. Publicity is a good thing. Is not the danger the manner of the publicity, when drug taking is presented by the Press as part of the good life, instead of as part of an early death? There has been a tendency to present drug taking as part of high life generally rather than as dangerous.
§ Mr. Braine
There may be such a tendency in the newspapers which the hon. Gentleman reads, but I would acquit our Press—certainly, the newspapers that I read—of anything of the kind. The Press has done its level best to focus attention in the last year or two upon this growing menace which is undermining so many young people. I would not attack the Press on that score.
An awareness of this danger must be brought home to parents. Parents, in the first analysis, are responsible for their children. As the hon. Lady the Member for Exeter (Mrs. Gwyneth Dunwoody) illustrated in a most moving speech, often parents do not know what is happening to their children.
I was saying when I was interrupted by the hon. Member for Cheadle (Dr. Winstanley) that this publicity may be evidence—I hope that it is—of greater vigilance on the part of the authorities. Equally, it suggests that the problem has grown, and is growing, in extent. All this underlines the fact that the Bill cannot be judged in isolation.
Indeed, the Bill deals with only one aspect of the drug problem and with only one category of drugs—the dangerous drugs of addiction. It is a response to a particular situation within a much larger problem. It leaves the state of the law in relation to drugs in general in an unsatisfactory condition. Its success will depend wholly on the extent to which the Government provide really effective treatment in the proposed centres. There is some reason to believe—I hope that the Minister of Health can dispel the doubts on this score—that the Government's provisions in this regard are likely to fall short of what is required.
I want to develop these criticisms in a little more detail. Why are the Government still unable to bring forward comprehensive legislation covering the whole field of drugs—their manufacture, their 511 supply, and control over their use or abuse? Why do we have such a lagging, timid, piecemeal approach to what the medical and pharmaceutical professions, and many Members of the House, too, consider to be a related problem?
Four years ago, after the thalidomide tragedy, the Cohen Committe recommended the establishment of what we now know as the Dunlop Committee on the Safety of Drugs, and at that time it advised also that there was urgent need for comprehensive medicines legislation. This was accepted on all sides. I was at the Ministry of Health at the time, and I remember that we received inquiries about it from the Labour Party, then in opposition. Legislation was, if I remember aright, in a fairly advanced state of preparation when we left office in 1964. What has happened since?
With respect, I submit that it is not enough to say that the Bill before us today is concerned only with dangerous drugs and stems from the limited though important recommendations of the Brain Committee, while the matter to which I have just referred relates to medicines generally and stems from the different recommendations of the Cohen Committee. As so many speeches in the debate thus far have shown, there is a clear link, which the Brain Committee was precluded by its terms of reference from considering, between "soft" drugs and the more dangerous substances covered by this Bill. The law regarding "soft" drugs is still far from satisfactory.
Some people tell us that the taking of marijuana, hemp and the amphetamines is harmless. This was the subject of Mr. Manfred Mann's eloquent plea in the correspondence columns of The Times. That is nonsense. For some time now the World Health Organisation doctors have been worried that cannabis smoking is not only debilitating and dangerous to health, but its users graduate to heroin. This has been a well-established fact in the world drug scene for some time. In this country, until recently, it has not been a serious problem, but there is now plenty of medical evidence that young people addicted to heroin started on the so-called "soft" drugs.
In a hospital not far from here, there were last year a number of young nar- 512 cotic addicts who had previously taken amphetamines, and they had started to do so at the average age for the males of 16½ and for the females just under 16. There is plenty of evidence that there is a direct connection between amphetamine taking leading on to heroin addiction. But this legislation does not deal with that problem at all.
I was interested to hear that there may be a possibility at a later stage of the Bill of considering strengthening its provisions in respect of certain matters, though these were not clearly specified. Perhaps the Minister will enlighten us on this when he replies. It is true that amphetamines have been on the scheduled list since 1964, but there are other drugs—I shall not mention their names—which can still be bought over the counter without prescription and which, technically speaking, are neither drugs of habitation nor dangerous drugs, but which, nevertheless, can lead and have led people, including young persons, down the path to more dangerous habits.
My first question to the Minister, therefore, is this: when are we to have the comprehensive legislation which the medical and pharmaceutical professions have been expecting for some time now?
My second point concerns the treatment facilities for drug addicts. I am sure that the Minister will concede that it has been extraordinarily difficult for us to find out what has been done or what is being done in this field. On the one hand, we know that the number of known addicts is rising sharply and will rise further. In other words, we know what the likely demand should be on the basis of the known figures. On the other hand, the provision of treatment centres, if I understand aright, is not expected to cause an appreciable strain on the resources of the National Health Service.
On 13th February, I asked the Minister of Health to statethe estimated cost of the special centres it is proposed to set up for the treatment of drug addicts, and whether this will be financed out of additional Exchequer money or by cuts in other parts of the National Health Service.The right hon. Gentleman replied:Such an estimate cannot yet be made.I would like to know whether he is in a position to give us an estimate tonight.
All hospitals are given additional money each year for developments, and I do not expect 513 the cost of these additional treatment facilities to require cuts in other parts of the National Health Service."—[OFFICIAL REPORT, 13th February, 1967; Vol. 741, c. 5.]That was a perfect Parliamentary Answer. It was short. I am sure that it was absolutely accurate, but it did not tell us anything that we did not know already.
Considering the difficulty in the hospital service now of finding enough money to meet existing priorities—no one knows this better than the Minister himself, who is battling valiantly to maintain an efficient service for the patient—that Answer was quite extraordinary. It can only mean that he does not expect that the treatment centres will cater for very many addicts or cost very much money. That is the only conclusion one can reach, unless it is proposed that other services are to be cut, and I cannot for a moment believe that the Minister contemplates that. I hope, therefore, that he will be a bit more forthcoming when he replies tonight.
What alarms me about the proposed arrangements is that the Government are doing two things under the Bill which, unless I am mistaken, are incompatible. They are banning the prescription of "hard" drugs by the general practitioner before we can be certain that we have an adequate network of treatment centres throughout the country, adequate, that is, to deal with all the known addicts and the others who are not known, but who, we hope will be attracted into treatment centres.
Hitherto, the view has been that the problem is limited to London and a few big centres. I assume that the Minister has abandoned that idea and that he now knows that it has been rapidly spreading through the country. If an addict is unable to find a treatment centre near his home, he will not use the facilities. Yet he is now to be deprived of any chance of treatment by a doctor on his doorstep.
The Government have rejected the idea of compulsory treatment for hard drug addiction, which is the practice in the United States of America. They may be right. It is a difficult question touching upon the liberty of the subject. Perhaps we ought to experiment first to find out whether a voluntary system is likely to work. But some doctors already working in this field tell me that they 514 are certain that compulsory detention is necessary if permanent cure is effected. The Americans seem quite convinced of this both on medical grounds and for other reasons.
My right hon. Friend referred to the President's Commission on Crime in America, which took the view, supported by the American Medical Association, that out-patient treatment in clinics was not the answer and that compulsory detention was necessary. This has since been followed up by legislation. I entirely agree that we should treat the addict as a sick person and not as a criminal, but we should not forget that the addict is a person who—some of the speeches in the debate have emphasised this—can draw others into the same behaviour. In the American narcotics law, an addict is defined as… any individual who habitually uses a narcotic drug so as to endanger the public morals, health, safety, or welfare, or who is so far addicted to the use of narcotic drugs as to have lost the power of self-control with respect to his addiction.In other words, it is recognised that he is a danger not merely to himself but to society as a whole. Detention on the American pattern is a pretty drastic remedy.
I am not criticising the Government for not following that course. They may or may not be right; only time will tell. But it follows as surely as day follows night that if treatment is not to be compulsory, and we are to treat addicts as sick people and not criminals, they should have access to doctors in the community who will be under an obligation to prescribe the minimum necessary for their needs. In any event, during rehabilitation there will have to be such doctors in the community to deal with the point raised by the hon. Lady the Member for Exeter as to what happens to the addict who has been to a treatment centre, and then returns to the community. How is his rehabilitation to be effected? That brings me to a suggestion that I wish to make. The Bill is framed on the Brain Committee's recommendations, which were made at a time when there was not considered to be an illicit traffic in drugs. That situation may have changed. We have been talking about known addicts going to the treatment 515 centres, but we know that a large number of people not registered with the authorities are addicted to drugs. What about them? Where are they to go?
If it is impossible for the addict to get drugs legally he will get them illegally. Banning treatment by general practitioners will create a vacuum. I suppose that the Government think that by setting up a few treatment centres they will solve the problem, but the American experience should be a terrible warning to us. Because of the big money involved, the vacuum will be filled by criminal elements. Britain has been relatively free from the horrible trade in narcotics until now. The Government may be taking a step—I hope that they are not—which will encourage the growth of that traffic here unless the treatment centres cover the whole country and offer really effective treatment to the addict.
It seems to me that there is a simple way round the problem. I return to the suggestion I made in the debate on 30th January, namely, that a network of approved doctors should be set up to whom addicts can go, doctors who are specially trained and equipped to deal with the problem. It may be that they will have to be specially trained and remunerated, but I am sure that they can be found. That is not a novel idea; it was suggested by the B.M.A. working party, which recommended that in addition to the treatment centres panels of approved doctors should be set up throughout the country, similar to the doctors on the obstetric list. I hope that on this point the Government will look at arrangements they are making to meet a problem, which is all the more disturbing since neither they nor we, after all the discussion, really know how grave and extensive it is.
§ 6.24 p.m.
§ Mr. Marcus Worsley (Chelsea)
The debate has ranged widely, as it should, and it has been one of its good features that we have set the Bill in the broader picture of drug addiction as a whole. But I should like to deal more narrowly with the Bill.
First, the Bill creates a system of notification, and I want to say nothing on that. Secondly, it sets up a cumbrous piece of machinery to discipline a very small number of over-prescribing doctors 516 —an enormous nutcracker to crack a very small nut. The Brain Committee's estimate of not more than six such doctors has already been quoted in the debate. I find it hard to understand why the ordinary procedure of medical discipline failed to deal with that phenomenon, involving a small number of doctors, and with the glaring examples quoted by the Brain Committee and again by my right hon. Friend the Member for Reigate (Sir J. Vaughan-Morgan). I do not understand how abuses on that scale have been allowed in a profession which has its own procedure for self-discipline.
Nevertheless, the Brain Committee said that the present self-disciplinary powers of the medical profession were inadequate to deal with the problem, and every medical hon. Member who has spoken today appeared to agree. I accept that. But it is very important that new sanctions, if they are needed, should as far as possible be the normal ones of medical discipline, and that the threat of the courts should be avoided.
It is no good saying, as one can legitimately say, that the courts are only a very ultimate deterrent. The fact is that under the Bill the ultimate deterrent is the court, and I should have thought that it would be better to have the same deterrent as the medical profession imposes on itself for other forms of unprofessional conduct, namely, de-registration.
We were told by the right hon. Lady the Minister of State, Home Office, that the General Medical Council had declined to take part in the Bill's disciplinary provisions. I regret that. It is a pity to establish a totally different disciplinary procedure in this matter, and I cannot see the need for it. I do not think that it is a very large matter. I should have thought it far better to build it into the existing self-disciplinary procedures of the profession.
If one talks in terms of an ultimate sanction in the courts there is a real risk of deterring a certain number of the dedicated and bona fide doctors who are interested in this work. We shall have to encourage doctors to take an interest in the matter of treatment and do nothing to discourage them, but we shall discourage them if we talk of courts and the criminal law.
517 The second and much more important effect of the Bill, flowing from the first, is to set up a completely new system for the treatment of drug addiction based on licence—the Home Secretary's licence. I am worried that it is to be his licence and not that of the Minister of Health. We are all agreed that over-prescribing must be stopped. But from that point on a licence should be granted only for strictly medical reasons of providing the best form of treatment. Surely it is the Minister of Health and not the Home Secretary who is best qualified to do this.
I hope that the Minister of Health will say something about the actual machinery which it is intended to set up to supervise the granting of these licences. When he spoke in January, he talked as if the treatment centres would in every case be in the psychiatric wards of hospitals. He certainly gave me that impression. In this, he was following the Brain Committee, although that Committee used slightly less strong words. It said that these centres might be in psychiatric wards while he said that he envisaged that they would be.
I queried that attitude in the January debate and I want to expand a little on the point. I regard it as the most important thing that I have to say tonight. I believe that if we must have a licensing system it must be as flexible as we can possibly get it. It must provide within it for treatment in different places and in different ways. Many hon. Members have stressed the experimental nature of all we are doing and our lack of knowledge. If this is so, surely the treatment centres must be set up in many different ways and we must be willing to experiment.
This, in particular, is why I have asked about the type of licensing system envisaged. I believe that there will have to be a continuing search for new methods, not just the setting-up of centres in hospitals. There will have to be a continuing process of licensing. I am not sure that the Home Office is well qualified to do that.
One cannot say—and the Brain Committee certainly did not—that psychiatric wards are the only acceptable places for treatment. I believe that they are likely to deter a great many addicts. I am not saying that the treatment centres should not be under the general control of 518 psychiatric hospitals, but that they should not necessarily be actually situated in the hospitals. Otherwise, I repeat, we will deter many people who should be going to centres.
There will probably be in the first place—and here I echo something said by my hon. Friend the Member for Essex, South-East (Mr. Braine)—the need to maintain a certain number of general practitioners as licensed treaters of addiction. In January, the Minister was extremely evasive on the financing side. I hope that he will be less so today. He said that it would be up to the regional hospital boards and that they had money for development. I simply do not believe that the boards will find themselves able to devote enough of their scarce resources to this extremely expensive and labour-demanding form of treatment. The figure of one in three has been quoted. I have heard a figure as high as one in one.
If the Minister sticks to his plan of treatment of all addicts in psychiatric wards, there is bound to follow a shortage of treatment facilities for addicts and if that happens then we are straight on to the black market. The evidence was given to the Brain Committee, reported by it and repeated again today, that if we do this we shall be needlessly be making the same mistakes as the Americans made a generation or more ago and about which they continuously warn us.
We shall need a much more flexible and experimental system of treatment than either the Minister or the Brain Committee have so far suggested. I accept that it may be necessary to license for reasons of prevention of over-prescribing, but I beg the Minister to reconsider the sort of places in which treatment should take place. It is absolutely vital that there should not develop a gap between the present situation and a future situation.
Everything I have suggested is possible under the Bill. The terms of licensing are extremely broadly expressed at the moment. It is possible to provide all sorts of treatment under the Bill. But the fact is that the Government have firmly given the impression that there will be treatment only in hospitals. This is widely believed to be the case. The Government must indicate their plans very clearly and very soon.
To begin with, general practitioners are at the moment under notice, as it were, 519 that they are to be prevented from prescribing. It is clear that a certain number of doctors at present are going out of this particular form of treatment. I do not think that new general practitioners are likely to start providing for addicts if they are told that shortly they will have to stop again. So the gap can come simply because this Bill is passing through the House and before new provisions can be made within the National Health Service.
If it is even believed generally among addicts that a gap of this sort is likely, then we already have the opportunity for a black market to step in. It is known that there are black market channels in "soft" drugs. These channels could easily be switched, if the circumstances arose, into "hard" drugs. Therefore, the critical point will be reached over the next few weeks and months unless we can successfully bridge the gap between the present system which, although it has produced a limited amount of over-prescribing, has prevented a black market and has made the great majority of addicts go for some form of treatment, and a future system which I accept may have advantages. We are running a serious risk of falling into a gap between the two with results that could be disastrous.
§ 6.40 p.m.
§ Mr. Patrick Wolrige-Gordon (Aber-deenshire, East)
I welcome the Bill, but I have considerable reservations about the whole way of tackling the problem which go much deeper and wider than this Measure. I accept the vastness as well as the tragedy of the problem. I understand that drugs of one sort or another are easy to make or to obtain and that, in an almost literal sense, the problem is beyond human control. But are the Government apparently to concentrate on the question of addicts alone and leave those approaching addiction to the mercy of the drugs until their condition ensures them the mercy of the Bill? That seems to be closing the stable door after the horse has bolted.
Where is the line to be drawn as to what constitutes a dangerous drug? This is a matter of great perplexity to the layman, who does not know much about the subject and who has probably never seen the Schedule listing dangerous drugs and who, anyhow, would be baffled by the names in it if he had. For instance, I 520 have always imagined that the real danger of drugs comes when they take over the person and the taker's craving for them masters him to the extent that he cannot say no, and eventually they destroy his health.
If that is so, I imagine that some medical opinion would think that we did not have to go any further than tobacco, especially if there is any truth in the view that in some ways it is associated with cancer. But that is only one of many points in this subject when Parliament finds itself in a difficult and baffling position. Drugs can also be dangerous for others when, for example, they affect a person driving a motor car. The pedlar can have the most dangerous influence of all on other people.
In that context, almost any drug can render its taker a source of possible danger to others. It is a dangerous thing with which we are dealing and I believe that it is impossible to divorce the sad increase in drug taking in this country in recent years from the rest of the moral rot of which, unhappily, we now have so much evidence in Britain.
I know that at the moment it is fashionable to consider almost any kind of moral sickness as a disease which can be treated and for which no one need feel too responsible. It is a convenient way of looking at any problem, but if one accepts that, one marks the acceptance of that problem in greater or lesser degree for ever more. It cuts the chance of a permanent cure and we shall never have a permanent cure to drug taking unless we in Parliament make it clear that drug taking is wrong for a start. That is one obligation on Parliament.
Another is our example. I am not one of those who believe that Parliamentarians have to be limited solely to their legislation. I think that our example can do much in Britain for either good or ill, but I do not believe it to be logical for someone in the grip of the tobacco habit or the drink habit, for example, to think that he has a word which he can say to a young person in the grip of heroin; nor to the pedlar who sold it to him.
§ Mr. Speaker
I hesitate to interrupt the hon. Gentleman. I do not question a word he is saying, but it is a little wide of the Bill which we are debating on Second Reading.
§ Mr. Wolrige-Gordon
I am sorry if I have spread too far, Sir.
We are faced with a major problem and we have to consider every way in which we can meet it. We are in a difficulty if we do not approach the moral aspect of the problem as well. This is the difficulty which we will meet when we approach young people particularly, because young people are logical and when they have seen opinion in Parliament become increasingly permissive on so many other issues, they will find it hard to understand why Parliament even tries to draw a line at drug taking. Parliament will doubtless be able to explain it to its own satisfaction, but I doubt very much whether it will be able to do so to theirs as well.
Moreover, there is another anomaly about this legislation which may not help to make it any more effective. We have been told that its introduction is necessary for one thing in order to control the pedlar and that only if we make this traffic illegal can we stop it. However, we have been told exactly the opposite about, for example, the Medical Termination of Pregnancy Bill. In that connection we were told that only if the traffic were made legal—
§ Mr. Speaker
Again, I do not question what the hon. Gentleman is saying, but he cannot review the whole state of morality in the country on this narrow Bill. He must keep to something which has to do with the Bill.
§ Mr. Wolrige-Gordon
I was merely pointing out that to try to have it both ways does not make legislation particularly convincing. Personally, I believe that it is unduly optimistic to think that once a practice has been legalised it can, therefore, be controlled.
There is also doubt whether the measures proposed in the Bill will be effective even for the limited objectives at which the Bill is aimed. Much will depend on the amount of money which is spent. A similar kind of exercise with alcoholics has not been adequate. If distribution of heroin by the hand of official bodies does not work, the addict will clearly be drawn to the black market, with infinitely worse results for both him and society as a whole.
522 I want to fight drug-taking in every way open to us and the Bill is at least an instrument in the battle, for which reason I welcome it. However, I still believe that the real malaise lies much deeper in the moral and spiritual starvation in this country which Parliament must solve before this kind of symptom, which is what drug-taking is, will itself disappear. Heightened standards and the re-establishment of character as a national aim is essential and the greatest necessity is a target big enough to interest and include everybody. Restrictive measures by themselves will not be enough.
§ 6.46 p.m.
§ Mr. Quintin Hogg (St. Marylebone)
I have listened to every speech in the debate, from which I have learned a great deal. Normally, Home Office business rather tends to be attached to the legal and, rightly or wrongly, I feel that I move in that field with a certain amount of assurance, based on some experience. But I do not feel the same sure-footedness with this aspect of the subject. For that reason I was particularly glad that the opening speech from this side of the House was delivered with such skill and eloquence by my right hon. Friend the Member for Ashford (Mr. Deedes), whose special interest in this problem has been a great deal of help to the House and a great deal of help to his colleagues who have had to speak about it. As I do not claim to be in any way an expert on the subject, I shall confine my remarks to one or two practical comments.
Anybody who reads the Bill, as the right hon. Lady pointed out when she moved the Second Reading, will realise that the substance of the policy to which it is designed to give effect is not written in the Bill itself. The Bill is an enabling Bill, enabling the institution of regulations and the mechanism for enforcement, but the success or failure of the policy will depend upon the things which are done on the ground. The right hon. Lady told us something about those things, but I hope that the right hon. Gentleman the Minister of Health will tell us something more.
He has opted in favour of treatment centres. These have the support of the Brain Committee and there has been little 523 serious criticism of them in the debate this evening. But how many are there to be? How will they operate? What will they look like in practice? If some of the figures which we have been given are correct, that is to say, my right hon. Friend says that there are about 2,000 addicts of one sort or another at present in existence of whom he said—and he may be right—that about 1,600 are in London, how many centres are there to be and where are they to be placed? I doubt whether there will be more than ten. That means that 160 addicts will attend each centre. I am trying to get a picture of what is to be done. How often will those addicts have to attend the centre? One has a mental picture of 160 addicts attending each of these centres at least once a day.
How often will they have to attend? How many doses will an addict have to receive at the centre? Will he receive all of the dose there, or will he be given some to take away with him, and if so how will he administer it, and how often? Presumably it will be quite a formidable administrative problem if people who are on the verge of leaving ordinary life altogether have to attend a centre for treatment, to receive treatment at regular intervals, and have to attend in considerable numbers possibly meeting other addicts and possibly taking away some quantities of the drugs to which they are addicted.
There is a very real evil to be corn-batted, but the advantage, such as it is, of the present system is that the addicts are spread over a number of doctors, and not concentrated at centres, and they receive their treatment in private. When these centres are established, the approach of these addicts to them will be something which can be observed, indeed reported in the Press if need be. How does the Minister view that?
There is also the question of money. The Minister must give us an answer about the financial arrangements. We all know enough about financial administration to know that one of two alternatives must be true. Either the money to set up these centres, which will not be inconsiderable, will be new money, or it will not. I understand the constitutional point made by the right hon. Gentleman in January that we did not, apparently in 524 theory at any rate, earmark grants to hospitals. I understand the importance of this, but in the last analysis the money will either be new or it will not.
If it is not new money, someone else will suffer for the institution of these centres. My hon. Friends have made it plain that, although one may not be able to put one's finger on who is to suffer, some of the things needed so badly by the Health Service will have to be done without unless new money is available. Will not the right hon. Gentleman come clean and tell us that in spite of the point about earmarking, in substance, the money to provide these centres will be new money?
He ought to do so. One realises the danger of an Opposition pressing for expenditure. The Prime Minister can get up and say that we are very keen to demand reductions in taxation, at the same time pressing the Government to provide new money for expenditure. There may be something in this, but it will not be the first time that an Opposition has suffered in this way. It may also be one of the duties of an Opposition to press a Government for suitable expenditure. Will the right hon. Gentleman not tell us where the money for these centres is to come from?
There has rightly been a certain amount of discussion as to the relationship between these so-called "hard" drugs and the "soft" drugs, sometimes of the modern kind with letters of the alphabet to describe them. There has also been discussion of the older kind like cannabis. This was quite rightly referred to by my hon. Friend the Member for Ashford. Cannabis is hashish. Hashish is the actual drug which gave the name "assassin", because the assassin was a man who committed deliberate and violent murder under the influence of hashish. He was employed by the Old Man of the Mountains, as he was called, the Sheikh al Gibal. One should realise that a very great number of mental patients in the Near East are hashish addicts.
I am told that I must not use the word Addict in connection with hashish. There is an esoteric distinction which we must observe between addiction, which is only applicable to heroin and morphine, and dependency. My right hon. Friend tells me that I am dependent on chocolate, 525 but not addicted to it. This is all very well; these philosophical distinctions are very important indeed.
I hope that the right hon. Gentleman, in winding up, will say that he will not be lured by "pop" singers or stars who write to The Times about letting up on cannabis. I hope that he and the right hon. Lady and her right hon. Friend will pursue the addicts of hashish or pot, or marijuana, or whatever it is called, with the utmost severity that the law allows. I hope that they will find themselves in the Old Bailey, and, however distinguished their pop position in the Top Ten may be, that they will be treated by the judges at the Old Bailey as criminals deserve to be treated, and I hope that there will be no mercy shown them at all.
That really sums up what I want to say in principle about the Bill. I thought that there was a good deal in what my hon. Friend the Member for Aberdeenshire, East (Mr. Wolrige-Gordon) had to say about smoking. Whatever one can say of heroin, it does not kill 20,000 people a year, as cigarettes do, but it would be out of order to pursue that matter. We have said on this side of the House that we would give the Bill a fair wind and I hope that it may be said that we have kept this promise.
We may take a little credit for it, because when I told the right hon. Gentleman the Home Secretary of this I rather sensed that he was in difficulties with the Government in getting Parliamentary time for the Bill, so the Opposition can take a certain amount of satisfaction in the fact that the Bill has been introduced into the Government programme. At all events we are very glad that it has.
We did not think it altogether suitable for a Second Reading Committee. Although it is not controversial, a number of quite important issues of principle are involved. It would have been possible, not very long ago, to conceive that there would have been strong opposition to some of its proposals. After all, a doctor has to notify the authorities that his patient, who may have come to him for some other reason—as a result of a road accident for example—is an addict.
He is not allowed to prescribe for addiction, except under the regulations, allowing for treatment. If he does in the 526 last resort, and after having gone through the enforcement procedure, he can be directed not to prescribe. If he ignores this, he renders himself liable to very heavy penalties. It was right to bring all these things on to the Floor of the House. Those of us who have been in the Chamber to listen to it have heard a very profitable debate. I am very glad that it has revealed such relatively unanimous approval of what is to be done.
§ 7.0 p.m.
§ The Minister of Health (Mr. Kenneth Robinson)
I am sure that I speak for my right hon. Friends the Home Secretary and the Minister of State as well as for myself when I say that we cannot complain of the reception which the Bill has had today. The right hon. and learned Member for St. Marylebone (Mr. Hogg) asked me to confirm that the Opposition had redeemed their promise to give the Bill a fair wind. I am very happy to do that. I can say that they have more than redeemed their promise, because they insisted on a full day's debate. We have managed to get through the debate in rather less than a Parliamentary day.
Members have ranged very widely over problems resulting from the misuse of drugs, over possible solutions to those problems and, naturally, in more detail, over the action being taken or proposed by the Government, including the contents of the Bill. My right hon. Friend the Minister of State described very clearly the need for the Bill and commented on its principal Clauses placing new statutory duties and restrictions on doctors. I do not think it necessary for me to cover the same ground. I should like to remind the House, as did my right hon. Friend, of the perspective in which the Bill should be seen. It does not, and could not, stand in isolation. It forms an essential part of a scheme of interrelated measures designed to check the spread of addiction.
The Government were mildly criticised in one or two speeches—I think that the right hon. and learned Member for St. Marylebone mentioned it—for failing to tackle the problem of dependence on those drugs which are not categorised particularly as dangerous—I do not like calling them non-dangerous drugs—such as the amphetamines and barbiturates. I assure the House that the Government recognise that dependence on these drugs 527 presents a serious problem which affects many more people than those addicted to heroin and cocaine. But our approach is to break down drug problems into manageable sizes. We have attempted to do this with the "hard" drugs. Even so, very careful preparations and a fairly elaborate scheme of measures have been found necessary because of the complexity of the problem.
The Government are not by any means complacent about the forms of drug dependence which are not the subject of the Bill. The problem of addiction to the "soft" drugs will be watched very closely. I understand that the Advisory Committee, of which the right hon. Member for Ashford (Mr. Deedes) is a member, is looking into it, and should further legislation be appropriate the Government will be very ready to bring it forward.
Nearly all hon. Members who have spoken have asked a number of questions about treatment centres and particularly about the method of financing them. I wish to deal with both problems in a moment. Before doing so, may I deal with one or two specific points.
I echo the tributes paid on both sides of the House to the very thoughtful speech of the right hon. Member for Ashford. The House knows the very great interest which he has taken in this subject over many years, and we are very glad to have him as a member of the Advisory Committee. He said—and I certainly do not dissent from it—that with the Bill the Government are embarking on a new and possibly hazardous course. We are not unaware of the risks associated with what we hope is the best course by which to proceed. Nevertheless, we are acting in accordance with the best professional advice which we could get.
The right hon. Member for Ashford mentioned that the medical organisations in the United States take a different view from us as to the best solution. Fortunately, the problem is very different on the other side of the Atlantic; and I think that all of us profoundly hope that it stays very different. The right hon. Gentleman referred to the possibility of invoking Section 47 of the National Assistance Act in cases in which a heroin 528 addict is suffering dangerous self-neglect. I am informed that in some cases the Section might be appropriately invoked, but there are many difficulties, not least the fact that the sanctions, when one considers the nature of the problem, are almost derisory. However, we will give further thought to the right hon. Gentleman's suggestion.
I endorse the remarks of the right hon. Member for Ashford about the need to ensure that addicts who have been deprived of their source of income through the new arrangements should have recourse to what is now the Supplementary Benefits Commission. I am sure that he is absolutely right. They must be enabled to live as part of the process of treatment and, we hope, rehabilitation.
My hon. Friend the Member for Batley and Morley (Dr. Broughton) and the hon. Member for Cheadle (Dr. Winstanley) reassured the House that the measures proposed in the Bill are acceptable to the medical profession. I was very glad to hear their confirmation of what the Government understand as a result of the very considerable consultation which we have had. These are exceptional restrictions to place on a profession, but, nevertheless, the profession recognises, as does the House, that we are dealing with an exceptional problem.
The right hon. Member for Reigate (Sir J. Vaughan-Morgan) dealt mainly with the question of treatment centres. He said that it was a pity that notification of addicts should be made to the Home Office and not to my Department. Notification will be dealt with, if I may use the phrase, on the "medical network". Notification will be made to the Chief Medical Officer of the Home Office. The right hon. Gentleman will recall that the Chief Medical Officer of the Home Office just happens to be my Chief Medical Officer as well. I hope that he is, to some extent, reassured by that.
I wish to say something about the arrangements for treatment. In the last debate, I outlined the facilities which hospitals are to provide. Briefly, the new role of the hospital service is the provision of out-patient clinics for people addicted to heroin and cocaine who are not, for the time being, willing to undertake withdrawal treatment. Out-patient clinics will be linked with in-patient services either at the same hospital or at 529 another hospital so that an addict who attends as an out-patient can be given withdrawal treatment as soon as he is ready to accept it.
Last month, I sent a memorandum to hospital authorities setting out the facilities which are required for the treatment of people addicted to heroin and cocaine and asked them to introduce the new outpatient services on a small scale immediately and to be prepared to expand both out-patient and existing in-patient services at short notice to meet the increased demand which is expected to flow from this legislation. It is generally considered desirable to separate the treatment of heroin addicts from the treatment of other patients. Some addiction clinics may be held in existing out-patient departments but outside the usual hours and perhaps in the evening, while others may be provided in separate premises.
As the House knows, and as the right hon. Member for Ashford confirmed, the main concentration of addiction is in the London area. I have asked the boards of governors of London teaching hospitals with psychiatric departments to take on the major share of the out-patient services and the regional hospital boards to be mainly responsible for in-patient services. I expect that a number of hospitals will provide services of both kinds. Detailed planning is now proceeding, and practical questions of additional staff and accommodation are being dealt with. It is essential that hospital facilities should be ready to cope with whatever demand may arise when the regulations come into effect. It is important that the load should be fairly spread among the London hospitals, and I am very pleased that this has been recognised and accepted by them.
Out-patient facilities are available to a limited extent already in two London teaching hospitals. Plans for the expansion of one of them and for the introduction of out-patient facilities at four other London teaching hospitals are now well advanced. Subject to the necessary staff being recruited, I hope that they will be available very soon.
I hope that hon. Members will not press me at this moment to give the names of hospitals, because it might mean that addicts would tend to concentrate on them and the load would not be spread 530 evenly. General practitioners in the areas concerned will, of course, be made aware of the services as they become available—
§ Dr. Winstanley
The right hon. Gentleman is dealing with the availability of services and in which hospitals they will be available. Would he confirm that no consultant psychiatrist at any hospital who is at present treating drug addicts will have to stop as a result of this Measure?
§ Mr. Robinson
I would not like to anticipate exactly what will happen administratively about the licensing procedures. I am dealing at the moment with the provision of treatment centres. The point which the hon. Gentleman has made could perhaps be made in Committee.
There are four further teaching hospitals which will introduce a service, but these cannot start until the necessary accommodation is built. I have asked for plans to be drawn up urgently. In addition, there will be a contribution to out-patient facilities from the Metropolitan regional hospital boards. Out-patient facilities may thus be expected to be available generally in London before the legislation is put into operation.
Hon. Members have expressed anxiety about how the costs will be met. For fairly obvious reasons, the cost of the additional facilities cannot be estimated precisely at this stage. But, as I said in the debate on 30th January, it is likely to be very small in relation to the cost of the hospital service as a whole. I repeat that all hospital boards are given additional money each year for developments. They are given new money each year, to use the right hon. Gentleman's phrase. In general, I would expect them to be able to finance these treatment facilities in this way.
Let me assure the House that in the coming year, the hospital service is getting something like £50 million more than it had last year. Some of that is for increased pay and prices, but there is a very large part in that sum of new money for new developments.
Tn-patient services will be mainly at psychiatric hospitals, and I am sure that regional hospital boards will take that into account in allocating resources to hospital 531 management committees covering psychiatric hospitals where there will be in-patient treatment facilities.
I appreciate that it may be more difficult for the teaching hospitals whose budgets are a good deal smaller than those of the regional hospital boards. It may be more difficult for them to absorb the cost of the new service, even though they, too, get development money. They are aware that I am prepared, should it prove necessary, to make sufficient money available to them out of the very small contingency fund which my Ministry holds back for matters of that kind. Therefore, I see no reason why the development of the new facilities should be impeded by financial considerations.
New money has to be allocated every year on the basis of priorities, so therefore I have new money for this and other services. I am also pressed in the House to expand the facilities for intermittent dialysis for patients suffering from chronic renal failures, and this, also, costs money. Hospital authorities have to balance priorities within the amounts allocated to them. But I have no anxieties that these services will be restricted on any financial grounds.
§ Sir J. Vaughan-Morgan
Even if I accepted the right hon. Gentleman's argument about there being enough new money available, which I cannot with all sincerity say that I do, will he bear in mind that, from the point of view of watching the development of this service, in all the accounts of hospitals dealing with out-patient treatment it ought to be shown as a separate item so that some kind of check can be made by him as to how these developments are progressing?
§ Mr. Robinson
If the right hon. Gentleman suggests merely a refinement of present accounting procedures, that can be considered. It would be of great interest to know what it costs.
The point which I was developing is that we are making new money available and if I may for a moment make a political point, it is being made available in greater measure than was ever achieved by the party opposite when it was responsible for the National Health Service.
General practitioners will be informed through executive councils of the hospital 532 treatment facilities which are available for these addicts so that they will know where to refer those whom they are at present treating and those who seek treatment. When general practitioners have been notified of such hospital facilities, I hope that they will start to refer addicts to them even before the legislation comes into operation. It will be in the interests of the patients if we can achieve a gradual transition of addicts to the hospital service rather than a sudden shift which would be more difficult to meet satisfactorily.
As the House will realise, the hospital service and the statutory provisions of the Bill are complementary ways of seeking to eliminate the excessive prescribing of heroin and cocaine which has tended to spread adiction. I want to give an assurance of our intention to take necessary precautions against excessive prescribing in the hospital service. To take up the point which was made by the hon. Member for Cheadle, addicts will receive sympathetic treatment by professional staff who understand their needs. The precautions are designed for a single purpose, and that is to prevent addicts from obtaining more than they need.
First, the Bill provides for the licensing by the Home Secretary of those doctors who will be authorised to prescribe or supply restricted drugs. The details of licensing are at present under consideration, but, in answer to the hon. Member for Chelsea (Mr. Worsley) the present view of my right hon. Friend and myself is that in selected National Health Service hospitals the doctors who should receive licences are consultant psychiatrists in charge of treatment of persons addicted to heroin and cocaine, and certain other medical staff under their supervision. Where treatment is provided in approved centres outside the National Health Service similar criteria should no doubt apply.
Secondly, the form of treatment and the decision whether to supply an addict with drugs will rest with the licensed doctor. It is expected that, where possible, dosage will be determined by a short period of in-patient observation, but that will not be a condition of out-patient treatment.
§ Mr. Worsley
On the subject of licensing, does the right hon. Gentleman envisage that it will be done by a medical 533 authority or by the Home Office? I am not clear what he intended.
§ Mr. Robinson
My right hon. Friend the Home Secretary is responsible for drug control and, if the hon. Gentleman will read the Bill, he will see that at all stages my right hon. Friend is acting on the advice of representatives of the medical profession. There are advisory committees and advisory panels, either wholly or predominantly medical, set up as part of the arrangements under the Bill.
Thirdly, a scheme is being devised to prevent an addict from receiving supplies simultaneously from more than one hospital. The House will understand if I do not go into the details of the scheme which will enable hospitals both to check from a central index the identity of patients addicted to heroin and cocaine, and to be informed of any other hospital which might be providing treatment. Information about patients will, of course, be kept and used in confidence.
Finally, when a licensed doctor decides that an addict requires heroin, and this should be by way of prescription, it is necessary to eliminate the risk that the addict may tamper with the prescription. The arrangements which we have in mind are that the prescription shall be sent from the hospital direct to the hospital pharmacy or to a named retail chemist, and should not be given to the addict himself. Also, to avoid placing more than the minimum supply of drugs in the hands of an addict, there should be provision for the doctor to specify the intervals, for example one a day, when a supply should be dispensed.
I am confident that a satisfactory scheme will emerge from our discussions with the Pharmaceutical Society and chemists' representatives. This is, I think, part of the answer to one of the points made by the right hon. Gentleman, who asked whether it does not mean that addicts will have to go every day to get one day's supply.
§ Mr. Deedes
Would it be indiscreet to ask—I hope not—whether this will involve an identity card system?
§ Mr. Robinson
No. Everyone has a National Health service number, and the number will figure in the arrangements, but perhaps we can discuss the details at a later stage.
534 I hope I have convinced the House that we attach great importance to preventing excessive prescribing, and that the hospital service will take suitable precautions to complement the measures in the Bill.
The role of the hospital service is wider and more positive than this. We hope that when more addicts come to the new outpatient clinics, more will agree to accept withdrawal treatment, and that more will then be rehabilitated and restored to a normal life. Withdrawal treatment is, of course, only the first stage in the treatment, and obviously when patients leave hospital and return to their old environment there is a high risk of a relapse. This emphasises, as did many hon. Members, the need for effective rehabilitation, and this point was of course emphatically made by the Brain Committee. I share this view, and I am anxious to improve facilities for rehabilitation, but, as I told the House last time we debated this subject, there is no ready-made system of effective rehabilitation, and until one is evolved a high rate of relapse must be accepted as a feature of addiction.
Meanwhile, perhaps I might try to outline our approach to the problem. A conference of psychiatrists has advised that from a given number of addicts very few will be willing to persevere through both withdrawal treatment and the subsequent period of rehabilitation. It would therefore be unreasonable to provide rehabilitation services initially for more than a small proportion of addicts.
I recognise that if facilities for rehabilitation could be made more attractive to addicts, and more effective, demand for rehabilitation might increase, and this is my aim. I think it right, however, to warn the House that at present the scope for effective action by way of rehabilitation is limited by the reluctance or inability of many addicts to give up drugs.
§ Mr. Braine
What the right hon. Gentleman is saying is of great importance, and I think it underlines the suggestion made by the B.M.A. working party, which I repeated this afternoon, that outside the treatment centres there should be doctors in the community, specially licensed if necessary, to whom addicts can go, because from what the right hon. Gentleman said it seems that we are moving very slowly into the 535 provision of an adequate number of treatment centres covering the country as a whole. Will the right hon. Gentleman deal with that suggestion?
§ Mr. Robinson
The Government have thought about all these possibilities, and have come to the conclusion, in conjunction with the profession, that it is better that the licences should be limited to those doctors who are functioning at treatment centres, and I am sure that these will not be so far apart that the great majority of addicts will not find them reasonably accessible.
What do we know about the sort of facilities which should be provided for rehabilitation? The medical view of those with experience in the field is that the ingredients of rehabilitation are psychiatric supervision, social support, and regular employment, and that these should be provided in hostels run by local authorities, or by voluntary bodies, or jointly. It is clear that the rehabilitation of drug addicts is an area in which there is much need for experiment, that there is as yet no standard formula for general adoption, and that there is scope for valuable contributions by voluntary bodies.
I would not wish to give the impression that there is at present no provision for rehabilitation apart from the statutory services. There is, for example, the well-known convent at Spelthorne St. Mary, and the wide experience of the Salvation Army includes the care of addicts. Recently, the National Association of Drug Addiction, the Midland Committee for the Prevention of Addiction, and the Hill Farm Enterprise, also at Birmingham, have taken steps towards providing services for the rehabilitation of drug addicts. The Government welcome the initiative of these and other bodies, and think that they can be most valuable when they are linked with the statutory services.
The hon. Member for Chelsea thought that the Bill contained a cumbrous piece of machinery, and I think that the right hon. Gentleman expressed some sorrow that the disciplinary machinery could not be within the aegis of the General Medical Council. The hon. Gentleman said it was a pity that the Council had declined 536 to take this on, but it is a fact that the Council considered it was inappropriate for it to assume this responsibility, and it was therefore necessary to work out alternative disciplinary machinery, emphasising the provisional nature of these decisions all along the line. It appears a little cumbersome when described in the Bill, but basically it is fairly straightforward, and I think provides all reasonable safeguards for members of the profession.
In this speech I have informed the House in some detail of the action which the Government have in mind, and in conclusion it is perhaps hardly necessary for me to remind the House that our aim is not only to check the spread of addiction, and if possible to reduce it, but to try to establish the causes of this very disturbing social phenomenon, which are at present largely unknown.
We are embarking on research on a good many fronts in connection with this problem, and I think I told the House during the last debate that later this year we shall be setting up a special research unit at the Institute of Psychiatry in the Maudsley Hospital. The Bill forms an essential part of our measures to check addiction, and I ask hon. Members to give it a Second Reading.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).