HC Deb 25 July 1967 vol 751 cc623-40

7.34 a.m.

Mr. William Deedes (Ashford)

May I start by saying that I am sorry to have given the Minister of Health a disturbed night. Indeed, I feel a little sorry for myself. If he accepts, as I know he does, that one can hardly go to too much trouble over this matter of drug addiction and its treatment, he will agree that the hour is quite immaterial.

The establishment in London of treatment centres for addicts represents a major departure in our administration and they are to be the linchpin of our arrangements about the hard drug problem. The centres will be of critical importance and I know that the right hon. Gentleman accepts that on their success or failure may well turn the battle against drug addiction.

To judge from my analysis of the Home Office figures, the problem which the treatment centres will be called upon to meet appears to be getting progressively worse. These figures bear scrutiny. In 1964, the figure was 753 addicts and, in 1965, 927 addicts. The Minister of State, Home Office, gave me figures for the first nine months of 1966 showing that there were 1,036 addicts. In April, on the Second Reading of the Dangerous Drugs Bill, she gave a revised, or provisional figure, for those nine months, of 1,139. A few days ago the Home Secretary gave the final figure for 1966, to 31st December, which, he said, was 1,349.

On the face of it, it looks like an increase of 300 in the last three months. I know that one has to be careful about taking averages, because one does not know what the true figure is, but as I read these figures there are 300 in the last quarter, an average of 100 a month. It is not impossible, and if it is true it is very serious. The Home Secretary has admitted that he cannot estimate the total. We do not know.

This takes me to the first point that I want to raise. The London teaching hospitals are reckoning to deal with, broadly speaking, a total of 1,000 addicts. I hope that this will be treated as a highly provisional figure, for more than one reason. In the first place, it is a mistake to treat all addicts, even "hard" drug addicts, in one class. If I am not mistaken, there are quite a number in the London area who are running on perhaps one or two grains of heroin a day. They may run up to 15 grains, but there are a lot on the lower limits.

These people are not now going through the usual channels. The moment that the new arrangements come into force they will be joining the queues outside the London teaching hospitals. How many will appear is something about which no one can offer a reliable estimate, and that is why our arrangements for staff in the London have to be very tentative in terms of the final figure. The Ministry would be well advised to work on not less than 2,000, doubling the figure.

The trend is unmistakable, and it underlines how important it will be to achieve this transition successfully. I accept that they will have time. But this is taking time. The Ministry's first memorandum, sent out to hospitals, on the treatment and supervision of heroin addiction went out in March of this year. We have not got the Bill yet. We are still waiting Amendments from another place. We will not see those before the autumn, and this machinery is unlikely to be working until the early part of next year.

We must accept that. What I want to be sure about is that between now and the operating of the machinery the arrangements made are seen and accepted to be workable by the hospitals who have to put them into action. There is a lot of misgiving on this score, and it is partly to allow the right hon. Gentleman the chance to allay anxiety that I thought I would introduce this subject before we part for the Recess.

When the Bill left this House I thought that I understood the position about treatment centres, but since then, in the light of Government statements elsewhere, I have grown somewhat confused. I must not quote exchanges from another place, but after carefully studying the record I am left rather confused. Not that this matters. What does matter is that there is confusion among some people who are to be responsible for implementing these proposals.

In a statement made in another place, about ten days ago, the Government indicated broadly, that the psychiatric hospitals would provide most of the inpatient facilities for drug addicts and the teaching hospitals would look after the out-patient service. That we know and accepted. It went on to indicate that there are now in operation eleven outpatient clinics in London, and plans for four more are under urgent discussion.

What are these? Where do they come into the pattern, because I have not heard of this before? I am not clear, and nor are a lot of other people, about what this is supposed to represent in terms of the new arrangements. Are those outpatient clinics in the London teaching hospitals? Are they private clinics? What is their eventual rôle, It is a pity that one newspaper, in inquiring about all this, has published the names of some places. The Minister and I are, I think, agreed that no names should be mentioned in any circumstances. I do not ask for names. I ask only for enlightenment about these clinics.

What troubles me a great deal is that there is a difference between what the Government say and what the hospitals are saying. I have lately had cause to wonder whether the Government know what the hospitals are saying. Again, to give an example, on 26th June I had exchanges with the Minister. Among other things, I asked whether he knew that certain London teaching hospitals had expressed great misgivings about aspects of the scheme. The Minister replied, at col. 77, that he would be interested to hear further details of what I had said. As far as he was aware, there was no general dissent among those primarily concerned with this matter about the way the Department was proceeding.

I must assume that the right hon. Gentleman was not at that time aware that a confidential memorandum had been sent to his Ministry, which he should have seen, on behalf of the London teaching hospitals, making their misgivings abundantly clear. I shall not quote from the memorandum or mention its source, but it carried some disquieting questions and doubts, which were sup- ported by the administrators of the London teaching hospitals.

Since then—I quote this not because I think that it still obtains, but as an example of, I fear, the differences which sometimes arise between the Ministry and the teaching hospitals—a working party has got together and has met this week and something new has been hammered out. I hope that the Minister will be able to tell us that we are on the way to a more agreed solution. I hope that what have been differences of understanding between the London teaching hospitals and the Ministry will be ironed out before the final stages of the plan.

The Minister sees, I think, in his mind's eye, a dozen London teaching hospitals playing their part in all this. Their enthusiasm for it all is far from uniform. Some are willing—indeed, anxious—to play a part. Some are rather doubtful and reluctant. They are doubtful whether they can play a part. There is nothing disgraceful about this. It is natural that there should be a great difference of approach between the London teaching hospitals, but this must he taken into account in the arrangements which are being made.

The doubts and misgivings on certain matters expressed by those hospitals must not be brushed off. If I may mention three of them, the first is that the assessment of addict needs, from which most people envisage 48 hours of in-treatment and the use of beds, will be very difficult indeed. The moment these people begin to apply to the hospitals, the hospitals must make an assessment of their needs. It is no good taking a note from the previous doctor. They are worried about how this will be done without the extensive use of beds.

The second point is liaison between the centres. It is important that everyone should know what everyone else is doing. People are not happy about the sort of intelligence system which will have to be created and the links with the centre where notification is made. Staffing will be difficult, partly because of the lack of expertise and partly because experience has shown that everyone involved in the work must be an enthusiast. It is no good having anyone who is not enthusiastic. There is a shortage of people who are both expert and enthusiastic. The London hospitals naturally worry because they see themselves having to produce more bodies than exist.

The last point by which I illustrate their doubts is the question of hours. This is really crucial. The noble Lady in another place has indicated that the Minister does not wish to consider a 24-hour service—that is, an all around the clock service—in the London hospitals as a standard arrangement. She added, rather inconsequentially, that if any hospital would like to do it, it would be welcome.

But I wonder whether it really would be welcome. If one hospital were to undertake a 24-hour service in the London area I think that we should have a very curious result, because it would become the focal point for nearly every addict, and would distort the pattern. I think that the answer there is what a lot of medical opinion is expressing, that the maintenance programmes must be uniform. I hope the centres can operate on less than a 24-hour basis. They will be a great nuisance unless they can, but what we know is that the treatment of these people is a great nuisance. They keep and they demand irregular hours; they have their private emergencies; they have no sense of time, many of them; they lose their prescriptions and then they lose their heads.

It will be very difficult to operate this on less than 18 hours at most of the centres. I know that there has been an argument whether we really want the dozen teaching hospitals the Minister favours, or whether in the London area we should have four fairly big units, fully staffed. I am bound to say that I side entirely with the Ministry, because if we think in terms of 2,000 patients when four units would be unworkable. They would have to handle about 500 patients each.

Here I raise a point which, again, is causing a certain amount of anxiety. How is the prescribing for these people being envisaged? One or two hospitals are thinking at the moment in terms of a week's prescription which would be "cashed", as it were, by the chemist daily. But will this work? I should have thought that there would have to be close, continuing contact between the patients and the out-patients' unit.

I do not want to go on at this hour of the morning, and I will end by saying that the central point is that the system, if it is to work, must command the confidence of the hospitals required to work it. At the moment, I would not say that confidence is there. Their willingness to co-operate generally is beyond question, but they do see, what I am bound to say the Ministry does not appear to me to see, some of the difficulties which the detailed application of this plan will cause. They are more aware of its complexities than the Ministry. They are being asked to undertake a disagreeable and difficult job which will have disruptive effects on their own regimes, and I think they are entitled to consideration of their views.

I hope that the Minister will arm himself against the Treasury. The Treasury must be persuaded that its normal methods will not work here. I am not talking about money just now, but the Minister knows very well that the normal Treasury assessments will not work out here.

I leave this thought with him, that London has by far the biggest part of the problem. I am not disparaging what he and the Home Office are trying to do when I say that I am not sure we are going to produce the right, final answer for London on these present lines.

The Minister will have to think in terms of a central directorate in London, because I doubt whether the Ministry, on top of all its other work, will be able to handle these treatment centres. It is a most complex task we are embarking on. It involves the terms of a new Bill; it involves notification, intelligence, doctors; above all, it involves faultless liaison between hospitals. Endless complications will arise, from day to day and hour to hour. I do not think all this can be settled in the Minister's office.

Birmingham is well worth studying, and shows what a concerted, coherent, co-operative policy can do, on a scale of 1 million citizens, by way of directorship at the centre. I do not look for directorship at the centre of London, but I look for more than we have now. I beg the right hon. Gentleman to keep an open mind about some form of central control within treatment centres. I would like the right hon. Gentleman to think about this now, and not in a year's time, when it may be too late.

7.50 a.m.

Mr. Bernard Braine (Essex, South-East)

I begin by expressing appreciation from this side of the House that the Minister himself has decided to answer the serious matters raised by my right hon. Friend the Member for Ashford (Mr. Deedes). The Minister's presence is indicative of the seriousness of the subject, and I would like to think—I am sure that I am right about this—that it is recognition by him of the growing anxiety felt by members of the medical profession and social workers in the field combating the evil of drug abuse that the Government's measures fall short of what is required.

The Minister knows that both my right hon. Friend and I have been pressing him since the publication of the Second Report of the Brain Committee two years ago to speed action to deal with this growing problem. We have been told repeatedly, but in somewhat vague terms, that everything was in hand and that treatment was available in numerous hospitals and clinics, although the details have been difficult to find. But while the Dangerous Drugs Bill was going through the House, with every support from both sides, it became abundantly clear that full treatment facilities did not exist, and we wrung from the right hon. Gentleman the admission that the Bill would not be implemented until these were available.

This, incidentally, is the position two years after the Brain Committee concluded that addiction to hard drugs was becoming, to use its own words, an epidemic, and that coupled with compulsory notification of addicts special treatment centres would have to be provided. On 20th April the right hon. Gentleman said: I hope that treatment facilities will be ready on this scale by the time that the regulations are made."—[OFFICIAL REPORT, Standing Committee G, 20th April, 1967; c. 47.] That is what we had hoped, too.

On 3rd July, in reply to me, the right hon. Gentleman said: I have already made it clear that we shall not bring in the regulations prohibiting prescribing by general practitioners for addicts until we are satisfied that the hospital facilities are adequate."—[OFFICIAL REPORT, 3rd July, 1967; Vol. 749, c. 1239.] When will adequate treatment centres be available? Will they be ready by the end of the year, which will be two and a half years after the Brain Committee reported that we had an epidemic on our hands, or will they be ready some time later? if the answer is later, what interim arrangements will be made? How much longer will it be lawful for a doctor to sit in a Baker Street cafe dishing out prescriptions to any addict who cares to go to him and pay him money because adequate facilities are not available on the lines recommended so long ago?

Whenever any of us have pressed the Minister about this, we have been fobbed off with statements that facilities already exist in every hospital region in the country. On 3rd July, the right hon. Gentleman said: In-patient services for heroin addicts are available in all, and out-patient services in 12 regional hospital board areas; the need for expansion of services is being kept under review."—[OFFICIAL REPORT, 3rd July, 1967 Vol. 749. c. 1238.] I shall not quote from the Sunday Times article. I agree with my right hon. Friend. I thought it most unfortunate that particular hospitals which were said by the Ministry to be providing these facilities were named, especially as some of these hospitals said that this was a matter of surprise to them and they did not yet have the facilities. The article merely added to the confusion. Indeed, confusion has been piled on confusion by the extraordinary statements by Government spokesmen in another place during the passage of the Dangerous Drugs Bill, when the greatest difficulty was experienced in getting any details of the treatment centres planned in London.

Reference was made to 11 out-patient clinics. I understand that these have nothing to do with the treatment centres, which are crucial to the Bill and must be available once the right to prescribe hard drugs is withdrawn from general practitioners. When I suggested to the right hon. Gentleman on 26th June that the London teaching hospitals were doubtful that his plan for treatment centres would be workable he rejected the suggestion and said: There is no suggestion that the hospital authorities have told me that the system is unworkable. There are difficulties, of course. We always knew that there would be difficulties, and there has never been any denial from this Box that there are difficulties. But I have no evidence at present that the scheme is not progressing satisfactorily. I have already said that there are about 30 hospitals in the London area providing treatment at this moment"—[OFFICIAL REPORT, 26th June; Vol. 749, c. 77.] We must accept that that was the Minister's information at the time, and that he genuinely believed it.

But on 3rd July I pursued the matter further. I asked whether certain London teaching hospitals had told him that his scheme for out-patient facilities was unlikely to work in its present form, and would be inadequate to deal with the expected number of addicts. He replied: No such advice in those terms has reached me. Certainly some doctors in some London teaching hospitals have doubts about whether the scheme will succeed. None of us can be confident, as I have made abundantly clear on many occasions, but the suggestion that London teaching hospitals regard the scheme as unworkable is not confirmed by my information."—[OFFICIAL REPORT, 3rd July, 1967; Vol. 749, c. 1238.] There is also the question whether those hospitals were thinking of the scheme being unworkable within the time scale laid down by the Minister.

My right hon. Friend was right to raise the matter today. In the light of what he said and of the latest information, does the Minister still deny that that is the position? There has been a great deal of confusion and misunderstanding, and perhaps the Minister can clear it up. May I put the issue to him in another way? When he and his colleagues have talked about treatment facilities in hospitals, is it not clear that they have been talking about the present arrangements under which it is still lawful for a general practitioner to prescribe drugs for addicts, and that the hospital facilities they talk about provide psycho-therapy, but not necessarily maintenance in respect of drugs? Will he now realise that we are interested not in this situation, whether drugs can now be obtained by addicts from general practitioners, but in the situation that will obtain once the right to prescribe such drugs has been withdrawn from the general practitioners, which is the Government's intention.

Will he realise that we are interested not in the perpetuation of arrangements for continuing to supply drugs to addicts from what might be described as prescription centres, but with the setting up of treatment centres, where a relationship with the addict can be established which will help win him away from addiction? That is always a long, hard task, which is often impossible under present circumstances. We and the hospitals want to know what will be the pattern of treatment facilities after the regulations come into force, especially in London. Where will the treatment centres be? I am not asking for hospitals to be specifically named. How many will there be, and will these provide a pattern of uniform treatment to which my right hon. Friend referred, offering, perhaps, a 24-hour service?

I agree with my right hon. Friend; I do not mean by what I have said that we should pander to the addict. Those addicts who visit an out-patient clinic should know the times when the service is available. But there will have to be some treatment centres where a patient is retained for at least 48 hours for assessment. Adequate in-patients facilities are, therefore, a key to tackling the whole problem in a positive way.

If my right hon. Friend is right, there is a real conflict between what the Minister hopes to introduce when he brings in the regulations and what the London hospitals think is necessary. What we are trying to get resolved this morning is what appears to be two major points of disagreement. First, there is the scale of provision. My right hon. Friend asked whether the Home Office figures were related to reality. Is the right hon. Gentleman assuming a figure of 1,000 addicts requiring treatment facilities. The Home Office figures are in the region of 1,350 and those in the field put the total closer to 2,000. We must know the scale of the problem. Will the necessary beds be available by that time.

The second point of disagreement seems to arise out of the hospitals arguing that it is nonsense to launch a scheme of this kind without first ensuring effective liaison between treatment centres. These will necessarily be experimental and will need to compare results, and must have follow-up procedures and care in the community. But all this will depend on the recruitment and training of staff and the acquisition of suitable premises which do not exist at present. Surely the Minister is aware that the majority of young heroin addicts are unemployed and incapable of work, Immediately after treatment, they drift back to their old haunts and the very environment which led to their undoing. One leading psychiatrist in this field has told me that the relapse rate is extraordinarily high, perhaps of the order of 80 per cent. What is being done, therefore, to tackle the problem on the lines which some London teaching hospitals have advised.

There is nothing new in this advice. Leading figures in the field such as Dr. Max Glatt, of Bernard's Hospital, Southall, have described what sort of treatment centres should be set up and that these should be accompanied by proper follow-up and supporting services in the community. I must ask the right hon. Gentleman if the London teaching hospitals have told him that he is taking a grave risk in launching his scheme on its present lines?

Addiction to hard drugs is growing fast and addiction to soft drugs is becoming widespread, especially among young people. Despite the claim of the sloppy and irresponsible elements in our society that soft drugs are not harmful, we know that the majority of hard drug addicts started on amphetamines, marijuana and barbiturates. Time is not on the side of those who seek to control drug abuse. If the Minister has been deprived of the necessary resources to tackle the problem realistically he must shock his colleagues in the Government, of whom we are glad to see so many have joined him on the front bench, into speaking out and taking resolute action to stamp out this scourge. He is perfectly capable of doing this, as he is a man with great courage and integrity. I can assure him that he can rely on our support.

8.4 a.m.

The Minister of Health (Mr. Kenneth Robinson)

I am glad of this opportunity to discuss drug addiction, although none of us would have chosen this hour, but there is much that I should like to clear up. I thank the right hon. Member for Ashford (Mr. Deedes) for, as usual, a constructive and helpful speech. I would not, however, describe it as a "shot in the arm", which I thought was one of his more unhappy metaphors in this context.

Anxieties have been expressed in the House and outside which I would like to allay. I should explain that I shall be using the term "drug addicts" in this debate to mean addicts to heroin and cocaine, since it is to the treatment of these forms of addiction that the present measures are being directed.

It might be helpful if I began by explaining the ways in which hospitals can provide this treatment. I am often asked, and today has been no exception, how many treatment centres are or will be available, but the expression "treatment centres" is ambiguous. It could be used to mean part of a hospital given over exclusively to the treatment of addicts, or any hospital that provides specialised treatment, whether or not it is given in a unit that treats addicts exclusively. It may also be used to refer to the new out-patient services for heroin addicts which are being developed, or to both in-patient and out-patient services combined.

The organisation of hospital treatment facilities for drug addicts depends on several factors, such as the local prevalence of addiction, the scale of current and potential demand for treatment, the resources—staff and accommodation—that can be provided, and the views of hospital boards, taking account of medical advice, on the best way to organise treatment. It follows that treatment facilities are provided in different ways and that there is no standard package called a "treatment centre". I will outline the different types of treatment facilities that exist or are planned.

In most parts of the country, the prevalence of heroin addiction is thought to be very small, as is the demand for treatment. In-patient and out-patient treatment is available for those areas, if required, at most mental hospitals and at some psychiatric departments of general hospitals. Drug addicts will continue to be treated there with other patients unless they become sufficiently numerous to justify providing special facilities for them.

In Birmingham, where there is a concentration of addicts—but on a very much smaller scale than in London—one mental hospital, All Saints, provides inpatient and out-patient treatment. Heroin addicts are treated in a unit which specialises in addiction to drugs and to alcohol.

The major concentration of heroin addicts is in London and arrangements for treatment there are more complex. Most of the out-patient treatment is expected to be provided by teaching hospitals with psychiatric departments which are situated in central London. Some of these hospitals will have a few beds for in-patient treatment or assessment; all will have links with mental hospitals so that in-patient treatment or assessment can be arranged as soon as the patient is willing to enter hospital.

Some regional hospital boards are providing in-patient and out-patient treatment at the same hospital, mainly in mental hospitals outside central London. The extent to which drug addicts will be treated apart from other patients varies, and may well change in the light of experience. Some out-patient services are being provided in separate accommodation; most will be provided in existing premises at times when they are not in use for other patients. It is too soon to say whether doctors will judge it suitable to treat persons addicted to other drugs with the heroin addicts.

There is, therefore, variety in the form of service. Arrangements must be regarded as experimental and they will be evaluated in the usual way by the medical profession and by my Department. At this stage one simply cannot assert that any particular form of service is the right one. Similarly, within the framework of those services, it is for the clinicians to determine the treatment appropriate to each patient and I have no doubt that various methods will be used.

Returning to the meaning of "treatment centre" it is clear, I think, that there is no specific definition and it is probably better to refer to in-patient or to out-patient facilities, if these are intended, or to hospital treatment facilities if the service given embraces both. Having talked generally about treatment facilities, I want to say something about the particular problems in London, because I know that the House and particularly the right hon. Gentleman and the hon. Member for Essex, South-East (Mr. Braine), who have discussed this, are concerned that the main concentrations of addicts are adequately provided for.

It may be helpful if I explain the general basis on which the planning of provision for hospital treatment for addicts in London is being conducted. The underlying medical policy—and the way in which addicts are treated is essentially a matter of clinical judgment—was discussed and accepted at a conference of the psychiatrists concerned. The general conclusion was that outpatient facilities needed to be provided at a number of points, at both teaching and non-teaching hospitals. It was thought that if there were enough of these it would ensure that the task was shared and that no one hospital carried too heavy a load. It would also at least reduce the risk of perpetuating the mutual support for their addiction which addicts in large numbers engender.

The Metropolitan regional hospital boards and the London teaching hospital boards were asked to plan on this basis. The general expectation was that because most hospitals in the heart of London were teaching hospitals a considerable part of the out-patient task in that part of London would in practice fall to the teaching hospitals.

The urgency for meeting the need, as well as lack of space on hospital sites, rules out the possibility of new building, except as a relatively long-term measure. So, in practice, my Department has been considering with each teaching hospital and each regional board what existing buildings can be used, possibly with minor adaptations. The staffing problem, particularly the medical staffing, is again one which can be tackled only hospital by hospital in the light of the amount of additional time each consultant psychiatrist is able to spare and in the light of each consultant's views on the way in which he prefers to treat his patients.

In practice, therefore, the arrangements in the hospitals are likely to vary; there will not be a string of identical units, each run and manned in an identical way. Apart from the practical difficulties of achieving uniformity, the differing views of psychiatrists about methods of treatment and the need for greater experience in this field make it unlikely that a standard pattern of treatment will emerge in the immediate future.

I make these points because some people have said that my Department ought to have laid down a standard pattern. Even if practical difficulties and the need for greater experience had not prevented it we should not have done this because it is not my Department's function to dictate how treatment should be provided, nor indeed would I wish it to do so.

Mr. Marcus Worsley (Chelsea)

The right hon. Gentleman is speaking of treatment centres in every case in hospitals. Is he also considering treatment centres outside hospitals on the ground that these might be more approachable to addicts, being in a physically separate building, even though linked to hospitals?

Mr. Robinson

A good deal of thought has been given to this, but at the moment, as I have told the hon. Gentleman before, we are satisfied that we ought to start by providing these facilities in a hospital setting for a period at any rate after the Bill becomes operative and the regulations under it become operative.

I know that there has been some other doubts among individual members of hospital staff about the adequacy and nature of the provision proposed for London. I think that this is only to be expected in a situation in which new and radical thinking is called for, and that there need be cause for anxiety only if the doubts were really widespread. I am satisfied that they are not.

I know that some of the teaching hospital administrators have expressed misgivings. I confirm that the right hon. Gentleman is correct and that I had not seen the document in question on the date that he referred to. But these misgivings were largely based on a misconception, which I think has now been removed about the estimated number of addicts. I will try to explain how the misconception arose. In the United Kingdom 899 persons were known by the Home Office to have been heroin addicts at some time during 1966. Of these, 760 came to notice in the London area.

To obtain some guide to the number currently addicted, an inquiry was conducted in December among general practitioners in the London area who were known to treat heroin addicts. This showed that about 220 addicts were currently under the care of, and were receiv- ing prescriptions for heroin from, these doctors. Doubtless, others were receiving supplies from other sources, and some may well have been in hospital. I think that the later figures quoted by the right hon. Gentleman may well include addiction to drugs other than heroin and cocaine.

The working estimate produced by my Department after consultation with the Home Office and after examining most carefully all the available figures is, as the right hon. Gentleman thought, that out-patient provision should be planned for the possibility that up to 1,000 addicts in the London area may come forward for hospital out-patient treatment. The demand for treatment cannot be precisely estimated, but I am satisfied that, on the information which we have at present, it is reasonable to have this figure in mind in making plans. The figure is, of course, subject to revision in the light of any later information which may emerge.

So far, 10 hospitals in the London area provide in-patient treatment for drug addiction, and 13 provide outpatient treatment. In illustration of the varied way in which treatment is provided, at six of the latter—those where out-patient treatment is provided—a service is available in the casualty department 24 hours a day. At three others there is a service five days a week, and at the remaining four facilities are available less frequently. I ought to mention that, in the view of some psychiatrists, a service available to the addict as and when he pleases is a positive disadvantage because getting the addict to come at a definite time every so often is part of his training.

The right hon. Gentleman expressed some doubt about the weekly prescription arrangements. I remind him that this is the system which is operated at All Saint's, Birmingham, and has been for some time, with considerable success. We have no reason to believe that it cannot be adapted for the London area.

Until these services are developed to a point at which facilities are available generally, and until the notification regulations are introduced and there are reliable means of identification, it would be premature, and in the long run against the interests of the addicts themselves, to give publicity to the names of the hospitals. I gather that there is nothing between us about that. The hospital authorities have, however, been asked to notify executive councils of the services as they become available so that general practitioners in the areas can be made aware of them.

It is hoped that, by the end of the year, the services at several of the hospitals now providing facilities will have considerably expanded. Detailed arrangements are being discussed with the hospital authorities concerned, and it is not yet possible to say how many addicts a particular hospital will be able to manage. It is thus too early to be specific about the date when the outpatient provision planned will justify the introduction of regulations prohibiting the prescribing of heroin and cocaine by general practitioners for addicts. I can, however, assure the House that the change will not be made until we are satisfied that the hospital facilities are ready to take up the expected load, but I would expect this to take place not later than the new year.

The Parliamentary Secretary to the Treasury (Mr. John Silkin)

rose in his place and claimed to move, That the Question be now put.

Question, That the Question be now put, put and agreed to.

Question put accordingly and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

Committee Tomorrow.

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