§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Graham.]
§ 4.21 p.m.
§ Mr. A. W. Stallard (St. Pancras, North)
The topic that I wish to discuss is the decision of the Government not to proceed with the funding of the proposed South-East London detoxification service.
This decision has deeply shocked all those people in the professional, statutory and voluntary organisations who have spent nearly seven years researching and planning this desperately needed facility. My own involvement is as the chairman of the all-party parliamentary group of the Campaign for the Homeless and Rootless—CHAR—and we, of course, share the shock and disappointment. We are very perturbed, too, by the fact that many of the people closely concerned with the proposal first heard about the decision when it appeared in the press—not exactly a satisfactory arrangement. I was one of those who heard about it in that way, and I want to record my protest about that method of communicating such an important decision.
The sudden announcement contained a number of criticisms of the proposals for the service. I shall mention those during my remarks. First of all, I should like to restate the view of CHAR, the National Association for the Care and Resettlement of Offenders and FARE, and all their constituent organisations, as well as directors of social services and many leading consultants and medical experts in the field of alcoholism that this service is urgently needed.
I do not have time to read the letters, but I have received many expressing dismay and opposition to the decision.
The report of the experience of Britain's first experimental detoxification unit in Edinburgh showed that the change from the penal approach to combined medical-rehabilitation management can be carried out successfully. Clients benefit and the change need not be more costly, if, indeed, cost is the main consideration.
746 There is a great deal of public support, too, for the decriminalisation of drunkenness. Many people, myself included, feel that it is disgraceful that, although alcoholism has been regarded as a medical condition for several decades, we still send 2,700 people a year to prison for drunkenness, where they themselves are the victims of their offence, and less than 1 per cent. of the 110,000 annually who commit offences of drunkenness are taken to detoxification centres.
This South-East London service is urgently needed if recommendations contained in the 1971 report on habitual drunken offenders are ever to be implemented. Indeed, the sudden decision to axe this long-planned detoxification centre calls into question all Governments' commitments to carry out their own policy recommendations. Let us look at a few of them.
Section 34 of the Criminal Justice Act 1972 made it possible for homeless alcoholics to be provided with treatment and accommodation instead of being pushed through the courts and prisons. The 1973 DHSS circular 21/73, which dealt with community services for alcoholics, accepted that it was the Government's responsibility to see that such centres were set up. Six years later, and after much agitation, there are only two centres functioning in England, one in Leeds and one in Manchester. Everywhere else the chronic alcoholic continues to be punished by the penal system. This latest decision means that no detoxification centres are now planned for the Greater London area, despite the area's high incidence of habitual drunkenness.
In 1974, CHAR published a report entitled "Drunken Neglect", and with the help of the all-party group tried to inject some urgency into Government action. In 1975, the present Foreign Secretary, the then Minister, set up an advisory committee on alcoholism, along with a special sub-group, actively to promote a range of services needed by homeless alcoholics to combat both their homelessness and their chronic drinking problems. The advisory committee was wound up in April 1978 and the subgroup was disbanded, its work barely tackled.
In 1976, CHAR produced a further report entitled "Habitual Drunken Neglect" and publicly queried the DHSS 747 commitment to the South London detoxification centre, since at that time the proposal had been under discussion for about three years. Now, three years later, the DHSS has admitted by its sudden announcement its lack of commitment, after more than six years of pointless planning and expense.
I turn to some of the reasons why the DHSS has decided to abandon the project. First, it says that there are marked similarities between the proposed London centre and the Leeds and Manchester centres. Therefore, it says, this would not be a good guide as a national model. This criticism is not entirely true. Of course there are some similarities. Why not? The task is similar. But there are also significant differences. Manchester is predominantly a medical-based scheme, with little after-care provision. On the other hand, Leeds is more of a community-based housing and after-care scheme. South London was to combine the best of both those two experimental centres and to upgrade the services provided by them, hence the consortium of voluntary workers, statutory services, hospital treatment and the police.
The second objection is that the DHSS says that the implementation of the South London scheme would delay the completion of research evaluation. That is a strange criticism, when it has been the Government who have delayed the implementation of the South London proposal. Therefore, I do not think that the DHSS is in a position to make that criticism.
Thirdly, there are criticisms about the cost. This is a detailed, complicated argument which is far too long for me to indulge in now. I have sent a résumé of the consortium's views on cost to the Minister, and I hope that he will comment on them. I simply consider that the Government's view on this and other similar issues appears to be "Penny wise, pound foolish".
Why did not the Minister call the joint working party together to discuss these criticisms and other aspects before this sudden announcement? I am sure that it would have been possible to reach a mutually acceptable solution, and it is still not too late. What we are saying is that the Government, the DHSS and the rest of us must face the need for increased funding for these services. The Minister 748 will know that the cost of keeping a prisoner for one week—£112 at 1977 figures—far exceeds any comparable voluntary agency hostel figure.
Before I sit down, I should like to ask several questions. I hope that I shall receive helpful replies. Is the Minister aware of the pressure on the prison system, the police and the courts resulting from the failure to implement the recommendations of the 1971 Home Office report on habitual drunken offenders, and various other enabling legislation designed to divert habitual drunken offenders towards alternative provision? Is there any liaison between his Department and the Home Office on this question?
Is the Minister fully aware of the deep concern about the decision to terminate the advisory committee on alcoholism, the termination of the sub-group on the homeless alcoholic and the decision not to fund the South London detoxification unit? There has been no confirmation about continued financial support for the Leeds centre. Is my hon. Friend aware of the concern about the lack of confirmation of financial support needed for Leeds? Indeed, I understand that unless some confirmation is forthcoming very soon the staff at Leeds will be given their notice on 23 February and will not be able to retain one of the only two centres that are functioning.
Is the Minister aware that there is growing concern about what, if any, financial support will be provided by the DHSS for alcoholism services when the present arrangements under circular 21/73 come to an end next year? Do we know what is happening? Is the Minister aware that among many people there is a feeling growing that the Government are withdrawing from their commitment on these matters and from their responsibility to support adequately such services where they exist? Will the Minister give a categorical assurance today that the provision of detoxification centres will be excluded from any future proposed cuts in social services?
I hope that the Minister will say that this matter will not be left solely to the willing and dedicated voluntary organisations which are engaged in this question of alcoholism with little or no financial backing. It is unthinkable that a Labour Government should leave this grave and 749 increasing social problem to fester for lack of official financial support.
Finally, will the Minister assure us that a meeting of the joint working party will soon be convened for further discussions on this matter?
§ 4.31 p.m.
§ Mr. John Tilley (Lambeth, Central)
I am grateful to my hon. Friend the Member for St. Pancras, North (Mr. Stallard) for giving me time in which to contribute to this debate. He spelled out the fears that the decision has raised among national organisations which help the homeless and alcoholics. I should like to speak about the immediate and certain effects of the decision on the area which I represent.
South-East London, including the borough of Lambeth, where the project was to have been sited, is known to have a high proportion of men and women who are in desperate need of help with the problem of alcoholism. Anyone who knows the area must be aware of the large numbers of people who live, or rather barely exist, on those streets, usually with inadequate clothing and food, often sleeping rough in all weathers. The headquarters of the DHSS are in the heart of this area, so I am sure that Ministers and civil servants cannot plead ignorance of the problem.
Until now there had been some hope that effective help could be provided. The local hospital, St. Thomas', has the necessary medical expertise. The local police have co-operated because they see the futility and waste of time and money involved in dragging such people through a penal system which will only tend to worsen their plight. The local authority, the London borough of Lambeth, was keen to play its part in providing the back-up of after-care accommodation. The consortium of voluntary agencies which already run the services for alcoholics in the area have the experience and the dedication to carry out the expansion that is needed.
All these efforts are being made to help a group who are at the bottom of a community which is, as a whole, deeply underprivileged by national standards. By the Government's own admission, the northern half of the borough of Lambeth suffers more than any other part of the 750 city from the interlocking problems of bad housing, poor amenities and lack of jobs that the Government's inner city programme is trying to tackle.
Yet this decision makes a mockery of the high-sounding slogans of the inner city policy. At a time when every other Government Department is working hard to put resources into Lambeth—to reduce some of the inequalities and reverse the run-down of the area—the DHSS is set on taking resources away from the area.
This point was made in a recent letter from Lord Porchester, the chairman of the South-East Regional Planning Council, to the Secretary of State for the Environment, who is in overall control of the inner city programme.
Lord Porchester said in his letter:If the small urban programme resources are cancelled out by reductions in other central Government allocations, such as, in the Lambeth case, the area health authority's budget, scepticism is bound to creep into the local authority's approach to partnership …. If the Government's main policies and programmes are not directed in favour of the inner area, that is regrettable; if allocations are cut back, then partnership is made to seem a fiction.The decision is also a mockery of the stated democratic principles of inner city policy. The whole point of partnership committees in the inner city is that Government Departments and local authorities should work in co-ordination, and yet in this case the local council was not even consulted about the decision before it was taken. I would like to hear from the Minister why there was no consultation with the joint working party that has been planning the project for so long, and why there was no involvement of the Lambeth partnership committee.
I want to stress that we are not talking here about a project that is merely experimental in the sense that we do not know whether it will be effective. On the contrary, we are dealing with a project which is assured of a degree of success and is many years, even decades, overdue.
The ingredients of a small but significant advance are all there in South-East London, as I have spelt out—the skills, the care and the commitment. All that is lacking is the Government's contribution. I am afraid that the refusal by the Government will not only mean the loss of a chance to make a small step 751 forward. It will also mean a big step backward, as many of those who have been trying to help may now lose heart in the face of this inexplicable decision.
There can be no excuse for the Government. The project would have been a development—not a copy—of the centres in Leeds and Manchester. It would not have been lavishly staffed. The Government cannot plead shortage of money. There is no doubt that such a centre would quickly produce a saving in public expenditure if it made just the slightest dent on the number of alcoholics taken through our overcrowded courts and forced into our overcrowded prisons.
Many local people will feel that the only explanation lies in the determination of the DHSS to reduce the level of health services in the inner South-East London area. Because of the resistance that has been mounted by local people, those cuts have been postponed. Now another tack is being tried—that of cutting back on a proposed extension of health care in a specialised field.
The Minister may try to defend his Department against these accusations of undue delay, of excessive secrecy, of undermining the inner city programme, and of using this saddest and most destitute group of people as pawns in the fight to impose Health Service cuts. He may repeat the point made by his colleague in his letter that he would be willing to consider "a more modest proposal". We in South-East London would accept a more modest proposal if only we had a more modest problem and a more modest need. What we want to hear from the Minister is a firm commitment that the whole decision will be reviewed in the light of the facts put before him and in the light of the public reaction against the decision, and that he will carry out this review in full consultation with both the joint working party and the Lambeth partnership committee.
§ Sir Bernard Braine (Essex, South-East) rose—
§ Mr. Deputy Speaker (Sir Myer Galpern)
Order. If I call the hon. Member for Essex, South-East (Sir B. Braine), he must resume his seat before 4.40 p.m., because the Minister must have time in which to reply.
§ 4.37 p.m.
§ Sir Bernard Braine
That is a very fair proposal, Mr. Deputy Speaker, and I am indebted to you.
I support the initiative of the hon. Member for St. Pancras, North (Mr. Stallard) and thank him for raising a matter which has been causing grave concern to workers in the field of alcoholism, particularly in London.
As the Minister knows, I am chairman of the National Council on Alcoholism, which is directly concerned with the provision of treatment facilities for people with drink problems and for alcoholics, especially in our big cities. In October last I voiced my concern about this very matter in correspondence with the Minister, and in particular about the delay in reaching a decision about the future of the South London detoxification centre proposal. The Minister replied in November, telling me about the position at that time and indicating that a capital grant of about £34,000 had been authorised for hostel arrangements and that that was all he was able to do. For that we were all very grateful, but the Minister did not answer my question about the Government's policy towards detoxification units generally.
In the Minister's letter of 17 January that we all received, we were told that the main project had been turned down on grounds of cost. I appreciate very much the Government's dilemma over costs and do not wish to cause any embarrassment with them over this. However, the decision having been taken to fund the limited hostel project for up to two years, will the Under-Secretary now give us a firm guarantee that there will be full consultation between his officials and the South London consortium in that period in order to ensure continuity and development of the work that will be undertaken, other wise hearts will be broken, time will be lost and public money will be wasted?
I beg the Minister to accept that what his two hon. Friends have said in the debate is absolutely right. We are waging a major war against alcoholism, particularly in the big cities, and we want help, not hindrance. A guarantee of that kind would go some way towards remedying the damage that the Government's decision has caused.
§ 4.39 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I fully appreciate the concern felt by my hon. Friend the Member for St. Pancras, North (Mr. Stallard), my hon. Friend the Member for Lambeth, Central (Mr. Tilley) and the hon. Member for Essex, South-East (Sir B. Braine) about the decision not to proceed with funding the South London detoxification centre at St. Thomas' hospital. I shall explain in some detail the background thinking be-bind the decision and endeavour to answer the points raised.
The experimental detoxification centres stem from the report of the Home Office working party on habitual drunken offenders, published in 1971. This suggested a pilot scheme to test whether detoxification as part of the range of treatment and rehabilitation services could help drunken offenders. Because of the essentially therapeutic nature of the detoxification facilities recommended, these were brought within the ambit of my Department, which was already promoting improvements in services for alcoholics.
An important development which followed the 1971 report was the assumption by my Department of responsibility for promoting the provision of hostel facilities for alcoholics throughout the country. A new policy circular in 1973 emphasised that alcoholism was a growing problem which justified the coordination of services and facilities provided by health and local authorities and voluntary organisations with a greater emphasis on what the latter could provide to meet the varying needs of alcoholics. The circular announced a scheme to encourage voluntary organisations to provide more hostels with the aid of pump-priming grants from the Department.
My Department does not normally fund local projects. The extent to which it has directly funded experimental and pump-priming projects for alcoholics is quite exceptional. The aim is to find models for which the authorities concerned will be willing to take over financial responsibility and which other authorities will adopt elsewhere. This is essential. The Department cannot fund or run permanently from the centre 754 services for alcoholics, which must in the long term be part and parcel of local health and social services.
To have any chance of success, there must be a coherent pattern of local services for alcoholics of which a detoxification centre forms a logical part. This factor was also recognised by the 1971 report as being of crucial importance. This is why my Department has been so concerned to involve from the outset the local statutory authorities which would eventually have to foot the bill for continuing the experiments, if successful, and also to participate in monitorine these experiments.
The Weiler report recommended two centres, one to be in London, as a pilot scheme. In 1972, therefore, my Department invited regional health authorities to submit proposals for consideration. Only one region, Manchester, responded, and the proposal was agreed in 1973 The Manchester centre did not open, however, until November 1977, due to delays in the building programme. A centre in Leeds was approved in 1975 and opened in May 1976. My hon. Friend asked me about this. My Department undertook to grant-aid the Leeds centre for an experimental period of three years only, before the end of which the health and social services authorities would review its operation with a view to accepting financial responsibility for it thereafter, if successful. I hope that these authorities will feel ready shortly to discuss the position with officers of my Department, and that is what we intend to do in the next few months.
My Department was anxious from the outset, if this were possible, to establish a viable experimental centre in London and spent some three years trying to secure local agreement for a centre in Tower Hamlets, where the problem of homeless alcoholics is particularly acute. This came to nothing, however. Then proposals for a centre of St. Thomas' Hospital emerged, and these were approved in principle in 1976. The proposals came from the South-East London Consortium, a voluntary agency in partnership with Lambeth local authority and St. Thomas' health district, and were received by my Department in 1976.
The centre then envisaged would be different in concept from Leeds and Manchester—a different mix. It would have 755 provided a blend of NHS and voluntary services with local authority support and would have required fewer staff than Manchester or Leeds. This proposal was approved in principle in 1976. In 1977 and 1978, my Department, concerned at the delay in finalising the proposal, provided funds in an effort to speed it up. In May 1978, entirely revised proposals bearing many similarities to the Leeds and Manchester arrangements were submitted. A feature of the revised proposals was the considerable increase in professional staff to work in the centre. The cost of the revised proposals, of which we did not receive full details until September 1978, had increased considerably in real terms. The three-year detoxification experiments at Leeds and Manchester are expected to cost about £600,000 and £875,000 respectively—appreciably less than the £1.3 million required to finance the revised proposals for St. Thomas' over three years, including a nursing and social work staff of 17 and four respectively. The Leeds detoxification centre, by contrast, employs six nurses and six social workers. In Manchester, the detoxification centre is adjacent to the regional alcoholism treatment unit and shares nursing staff with it, and two social workers are provided by the local authority.
There were doubts from the statutory authorities in South-East London as to whether they would be able, given their other extensive commitments and priorities, to assume responsibility for the cost of the centre and associated facilities at the end of the three-year experimental period. I must emphasise at this point that the attitude of the statutory authorities participating in the experiment is an important indicator and guide to the attitudes of statutory authorities in other conurbations where services for homeless alcoholics are needed. My Department has undertaken to set up experiments to pilot and evaluate detoxification centres so that consideration may be given by health and local authorities generally to the inclusion of such centres in the local range of services for which they are responsible. Thus, the increased costs and scale of staffing proposed presented the Department with many difficulties.
The project had also to be seen within a wider context. Things had moved on since the Weiler report of 1971 and even 756 since the St. Thomas' project was approved in principle in 1976.
In 1973 there were 21 hostels already in existence providing 248 places. All were previously hostels for ex-offenders. This provision has been more than doubled. Currently there are more than 50 hostels providing some 650 places and receiving pump-priming grant aid from my Department. There has been a parallel expansion in provision of other facilities for alcoholism, particularly by voluntary agencies. There are now about 30 day centres for homeless single people. London already has a detoxification experiment of a simpler kind, for which my Department gives grant aid to the Salvation Army in Tower Hamlets. Hospital treatment facilities have also expanded. Detoxification is carried out for individual patients in many hospitals, both psychiatric and general, as part of their normal work. Every regional health authority now has at least one specialist alcoholism treatment unit. In all, there has been considerable progress.
Preliminary information, from my Department's reviews of the operation of the Leeds and Manchester detoxification centres, did not encourage us to believe that the more optimistic objectives were being achieved. The high proportion of repeated admissions does not suggest that many habitual drunken offenders are being motivated significantly to change their way of life. That is not to say that they are not being helped. But does the benefit they receive justify a high input of professional staff? Moreover, one of the main goals of the Weiler report recommendations was to "decriminalise" habitual drunken offenders and to prevent the procession of drunken offenders through the expensive revolving door of court appearances and prison sentences.
But, following the Criminal Law Act 1977, imprisonment is no longer a possible sentence for unaggravated drunkenness offences, and there are very few people in prison at any one time for any drunkenness offence. Police estimates of those eligible for referral to the South-East London detoxification centre were only some 40 per month. Experience at Manchester suggests that many offenders would not accept the offer of referral to the detoxification centre. We must await the results of the research evaluation before reaching final conclusions. But these 757 developments did not encourage us to commit substantial resources to an experiment in the same direction as the two centres already in operation.
Indeed, the House will recall that last autumn the Expenditure Committee, in its report on relieving pressure on the prison system, recommended that consideration should be given to a simpler and less elaborate detoxification centre of an overnight kind, coupled with counselling facilities. We also had before us the report of the advisory committee on alcoholism on the pattern and range of services for problem drinkers, published last autumn, which recommends the establishment of a co-ordinated service for problem drinkers with special entry points for the homeless. The comments of health authorities, local social services authorities and professional and voluntary organisations have been invited on the report by the end of this month.
As both of these recent reports recognised, until the research evaluation of the detoxification centres has been completed, my Department is not in a position to commend to authorities any particular model of detoxification centre, or even to assess the usefulness of setting up any more such centres. In this context a new experiment would have put back completion of the evaluation of the experimental programme from 1981 until 1984. Moreover, the increased cost of the centre would rule out the possibility of funding other experiments of a simpler kind which would take account of developments in the last few years.
Before going ahead, we had to ask ourselves whether the cost would be justified, whether the delay in completing the research programme would be justified and whether the project was likely to give us important new insights which we would not get from Leeds and Manchester. We have reached a stage where we should not have to wait very long to know whether and to what extent these forms of intervention are effective in helping drunken offenders. We decided that at this juncture it would be wrong to go ahead. To do so, as I have explained, would have held back the evaluation of the current experiments, and this could lead to confusion and delay in the development of a comprehensive range of services for homeless 758 alcoholics and problem drinkers generally. This would slow down the rate of progress which is being achieved.
I fully recognise that the decision not to support the St. Thomas' project must be very disappointing indeed to all the people in the consortium and those concerned in the health and local authorities who had worked hard upon the proposals. Such a decision is not taken lightly or overnight. When it first received the revised proposals, my Department simply sought to explore and understand the reasons why these had changed from those approved in principle. But a meeting arranged by the Department for that purpose in July 1978 had to be cancelled because not all the other parties could, in the event, be represented. Before another date could be arranged, information about costs, the attitudes of authorities and experience of the Leeds and Manchester experiments gradually accumulated to such an extent that it would have been misleading to hold a meeting on the basis that this project could at this juncture be supported. In the end we decided to take this hard decision on our own and to accept with regret that it would be unpopular with those who had worked so hard upon the project.
But we must continue to move forward. My colleagues and I are impressed by the degree of co-operation which has been developed between the consortium and the health and local authorities in South London in their partnership to develop the St. Thomas' project. We hope that those concerned will not let their disappointment prevent them from continuing to work together. We have offered to consider further assistance to the consortium and its partners if they come forward with an acceptable scheme to improve existing services for alcoholics in South-East London. Officers of my Department will shortly be meeting representatives of the consortium to discuss this offer. I am sure that more modest resources used in this way could achieve much more to strengthen the pattern of services for all problem drinkers, including homeless alcoholics, in South-East London than a three-year experiment which would be too expensive to continue. I am confident that the existing experimental projects and the range of research commissioned will be sufficient in scope and variety to enable a considered view 759 to be reached on the implications of the habitual drunken offenders report's recommendations on detoxification.
My hon. Friend has represented only too clearly the disappointment and concern of the voluntary organisations, whose devotion to the cause of helping problem drinkers is vital to a national strategy for this group of clients whose needs do not receive and command widespread sympathy and understanding.
It appears there is some misunderstanding of the Department's present policies in this field and the constraints upon it. I think it would help both the voluntary organisations and the Department to move forward in the directions in which we all want to go if they met in an endeavour to understand about each other's problems. Accordingly, I am asking officers of my Department to arrange a meeting with representatives of the voluntary organisations concerned with problem drinkers, which I hope will build upon the considerable progress which has been made in the past few years, iron out difficulties and lead to improvements in co-operation and understanding. I very 760 much hope that this offer will be taken up.
In the remaining time available to me, I should like to deal with my hon. Friend's more general points. Services to alcoholism have improved in many ways since 1971. But we perceived a need to make a special push on this front and appointed the advisory committee on alcoholism in 1975 for three years to advise on services. The committee has given important advice over the whole field and its reports on prevention and on the services for problem drinkers have been published. The next task is to follow up the far-reaching advice already received. The action in hand includes the preparation of a consultative document on the commitee's recommendations—
§ The Question having been proposed after Four o'clock, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at nine minutes to Five o'clock.