§ 11 am
§ Sir Bernard Braine (Castle Point)
I do not often quote my own speeches, but I think that it is relevant to say that on 21 December 1979 I drew the attention of the House to the escalation in the number of drug addicts in our society. I said that the evidence was there for all to see. I recall saying:We do not need to go to New York or to Rome to see the squalor or the degradation caused by drug abuse; it is on view here in our capital city."—[Official Report, 21 December 1979; Vol. 976, c. 1067.]Since then the problem has escalated further. It has spread outward from the big cities. It is rearing is head in quiet county towns in the shires, and it is raging in Wales and Scotland. It is no respecter of class or education. It is no more endemic in depressed areas than in relatively prosperous ones.
Last November, the Evening Echowhich circulates in my constituency reportedchildren of 12 in South-East Essex are hooked on the killer drug heroin as addiction rages out of control.A police spokesman in Southend-on-Sea was quoted as saying:Drugs, and heroin in particular, are a problem that is growing so fast it's quite uncontrollable … We are only scratching the surface with our inquiries and arrests.At the beginning of this week The Sunday Times reported on its front page:Thousands of teenagers in south-east London have become regular users of heroin in an alarming youth craze that is sweeping council estates from the Elephant and Castle to Bermondsey and Rotherhithe. In the northern part of the borough of Southwark there are about 1,000 regular users.The report went on to quote Dr. Judith Morgan, a consultant psychiatrist at Southwark's nearest drug dependency clinic who had said:It is not going too far to call this an epidemic.The report allegedsome of the new users are spending £200 a week on heroin. They obtain the money through theft and petty fraud—or by becoming dealers themselves. There are now 40 dealers operating within a half-mile radius of the Old Kent Road.We know that the number of addicts notified to the Home Office has increased dramatically. In 1974, 807 new addicts were notified; that was equivalent to about 67 a month. Last year, 4,200 were notified; that is equivalent to 350 a month. The Home Office knew of 10,271 addicts last year, but the field workers tell me that that represents only about one tenth of the total.
Even if one relies solely upon the Home Office figures up to 1982, it is clear that there has been a frightening escalation during the past decade. In approximately a five-year period from 1978 there has been a 57 per cent. increase in London, 93 per cent. in the south-east, 148 per cent. in Wales, 437 per cent. in Scotland and 480 per cent. in the Midlands. We do not yet have last year's figures—I do not know whether my hon. Friend will be able to produce them—but all the evidence is that the figures are soaring.
Despite these warning signs, there appears to be little understanding, or even concern, in this place, or in the country as a whole, about the immediate or even the long-term effects of what can only be described as a grave illness and a terrifying social evil, encouraged by the ruthless criminals who import and distribute illicit drugs.
I do not disguise from you, Mr. Deputy Speaker, that my purpose in raising this matter is to shock Parliament 656 and the public into an awareness of what is happening under their noses, and to obtain from the Government a clear statement of how they view the problem and that precisely they are doing about it.
Until the mid-1950s, the number of known addicts remained fairly stable—probably between 400 and 600. By last year the number was at least 10 times as many, and the figure of 50,000 used by people who are knowledgeable about what is happening does not include occasional and intermittent users.
The scene is also changing in other ways. Until two years ago most heroin addicts were in their 20s and 30s. Now much younger people—schoolchildren in fact—have started taking heroin. The reasons are complex, but one factor undoubtedly is a greatly increased supply which means that it is easier and cheaper to acquire. The heroin available is also much purer than it was in the past. Another factor is that the effect sought does not need to be obtained by injection as it can now be smoked and inhaled. Cocaine is also being taken more widely, and is being smoked rather than sniffed, a practice which carries great dangers to health.
Moreover, as this evil trade grows, it becomes more and more profitable and professional criminals become increasingly involved as the profits are substantially greater than those realised from major robberies. It is not too much to say that our society is being undermined and corrupted at the same time on a scale that few people seem to have grasped.
My first question to my hon. Friend the Under-Secretary is whether he has any idea of the scale of the problem and the rate at which it is now accelerating. He will know, of course, that there is a wide discrepancy between the number of addicts notified to the Home Office and the total number of addicts. But how wide is it? The Times of 4 May 1983 reported that when a doctor took over the regional drug dependence unit in Manchester in February 1982 there were 50 problem drug users on the books. Within about a year there were 1,000. If that was the experience of one doctor in a major British city, it is likely to have been repeated elsewhere. Does my hon. Friend know the true figure?
Then again, why is the age level of addiction dropping? Over 10 years ago, a survey by the Institute for the Study of Drug Dependence found that 9 per cent. of pupils in the 14 to 18 age group had taken drugs other than nicotine and alcohol. In some areas the incidence was far higher. In a study of 16 to 17-year-olds in Glasgow, it was found that one in eight of the sample had taken LSD. What would similar surveys reveal today? Have the Government the slightest idea? If not, should it not be a priority to find out?
What we do know is that the volume of illicitly imported heroin and cocaine is growing in an alarming fashion. One gets some idea from the seizures by our understaffed customs service. In 1981 the total quantity of heroin seized by customs officers was 93 kilograms, in 1982 it was 176 kilograms, and in 1983 it was 200 kilograms. Those were substantial quantities, but they represented only the tip of the iceberg.
Has my hon. Friend any idea of the fatalities among young people hooked on hard drugs? Has he any measurement of the cost to the nation of the ill health that is caused by drug addiction? He would agree, I am sure, that the effect on the health of the addict is appalling. Unsterilised methods of injection can lead to blood poisoning, gangrene and the amputation of limbs. About 657 8 per cent. of addicts are either carriers or are incubating infective hepatitis, which in some patients may lead to chronic liver disease, which can be fatal. The effects during pregnancy on a young woman and the baby she is carrying can be damaging and prolonged.
Premature death and suicide are the wages of drug abuse. But there is also a price that society must pay. There are also diverse psychiatric and psychological disorders which result in the addict becoming mentally unstable, insecure, deceitful, violent—sometimes very violent—and, because of the compelling need for money to satisfy the hunger for drugs and to buy the next dose, criminal as well.
A heroin addict's daily requirement may cost him from £60 to £100, or between £400 and £700 a week. Inevitably that is driving many to petty and violent crime, and prostitution. The police forces in all our major cities know that to be the case. They are battling against an almost impossible problem. To that we must add the devastating effects of the addict's behaviour upon his own family. Often the parents simply do not know what is happening and when they begin to realise what is happening are reluctant to accept it. The effect is devastating. It can lead to the break-up of hitherto stable and loving relationships, to marital breakdown and worse. Perhaps now one can begin to grasp the immensity of suffering that this problem is causing all over the land.
Since it was known that I was attempting to raise the matter, I have had many heartbreaking letters from parents. In some cases their addicted sons and daughters are no longer alive; in others the way back to sanity and health has been long, hard, painful and immensely costly. But in all cases the feeling of hopelessness was made worse by the difficulty in finding help or support.
Alas, so often the complaint is that general practitioners—the first line of defence against ill health—have little knowledge of the problem. Organisations that can help are difficult to find. Professional advice is often diverse and leads to confusion. That is the message conveyed to me by many of my correspondents. A distinguished consultant has written to me saying that treatment is rarely available within the National Health Service, and in many parts of the country there are no treatment centres whatsoever. Even where treatment facilities are available there is almost always a long delay, sometimes up to two months, before even an initial assessment of the addict can be provided, and an even longer delay—three months or more—before definitive treatment facilities are made available.
Let me summarise the position as regards treatment. First, in general, society does not want to know about the problems of drug addiction. There are many people in the NHS itself who do not want to know about it. For them drug addicts are problem children; there are higher priorities and more pressing needs elsewhere.
Second, there is a paucity of information for addicts and their families as to where help can be found during a time of crisis. I shall not weary the House by mentioning the experiences that have been recounted to me, but the word "despair" appears over and over again in letters. People ask, "To whom can we turn?", "Where can we get advice?", and "Where can we get help?" We must bear in mind that the addict himself is often unaware that he needs help, so the problem is very serious for his family.
658 Third, there is a lack of expert, comprehensive and sustained treatment within the NHS for the various phases of the drug addiction illness.
Fourth, doctors tell me that their own profession lacks understanding and knowledge of what is clearly an illness, even if it is largely self-inflicted, and should be treated as an illness.
As the House knows, I was chairman of the National Council on Alcoholism for some eight years. During that time I had an uphill task convincing people that alcoholism was an illness. In the early stages people did not want to know—alcoholics were a nuisance, their behaviour unpleasant and embarrassing. But that has changed, I am glad to say, and today there is a much wider understanding of the illness of alcoholism and what needs to be done to treat it. God help us in this country, if we ever reach the stage already reached in France, where half the hospital beds are occupied by patients with alcohol-related illnesses. That is another subject and I shall not pursue it this morning. But just as there has been a need for education about alcoholism, and just as there has been an awakening to its awful social and economic cost to our society, there is now a need to face up to what is happening in regard to drug abuse.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
Does my hon. Friend agree that everything that he has just said is clear evidence that calls which sometimes come from surprising quarters for the de-criminalisation of heroin abuse are, frankly, lunatic?
§ Sir Bernard Braine
I have always taken that view. I thought that my hon. Friend was about to refer to calls for the de-criminalisation of the possession of cannabis. Unless society has a clear idea of where it is going in relation to all drugs, it will sink into a position from which it will be difficult to rescue the victims. I entirely agree with my hon. Friend and I do not believe that Parliament, which is a responsible body, would ever agree to anything along those lines.
I am aware of the steps that my right hon. Friend the Secretary of State took last year following the report of the Advisory Council on the Misuse of Drugs. I do not dissent from the view that there is a need for co-ordinated activity between regional health authorities and voluntary agencies at the grass roots. I am not asking for a national solution to the problem, which must be dealt with in the regions. However, my understanding is that we are still a long way from full implementation of the sensible recommendations made by the advisory council about 16 months ago.
The plain truth is that regional health authorities do not appear either to me or to many people in the medical profession to be taking the problem as seriously as they should. In many parts of the country there are no services available for people with drug problems. There are no specialist services in the NHS in Cornwall, Devon, Wiltshire, Gloucestershire, Kent, Essex, Northamptonshire, Suffolk, Cumbria, Yorkshire, Hereford, Worcestershire, Leicestershire, Derbyshire, Durham, Bedfordshire, and in many other counties. I do not know about the position in Wales or Scotland. Even in London, where there are 15 specialist hospital services, some boroughs are outside the catchment areas of those services.
The advisory council made more than 40 recommendations, one of which was that each regional health authority 659 should ensure that the extent of problem drug-taking in its region should be monitored to assess the extent of the services required and should develop a policy for meeting local needs. I understand that my right hon. Friend the Secretary of State has asked the authorities to report to him by about September, but has he any idea of the extent to which such monitoring is being carried out? The months are slipping away and the problem is growing. More importantly, what new services are being introduced to meet regional needs?
I hope also that my hon. Friend the Under-Secretary of State will address his attention to two other pressing requirements. First, there is need for a major effort in drug abuse education in schools, and in university and medical schools. Second, there should be introduced specific training schemes in the treatment and management of drug addiction for the health professions.
§ Mr. Robert N. Wareing (Liverpool, West Derby)
I apologise to the hon. Member for Castle Point (Sir B. Braine) for not being present to hear the earlier part of his speech, which began earlier than was scheduled. Does he agree that, in relation to regional needs, there is some correlation between youth unemployment and drug addiction? In some parts of my constituency 94 per cent. of youngsters are unemployed. They have idle hours and no responsibilities and are ready and waiting for those dreadful people who abuse youngsters. Will he ask the Government to consider reversing the cuts in the customs and excise service so that more people can be employed to apprehend those criminals?
§ Sir Bernard Braine
The hon. Gentleman was not here at the beginning of my speech and he intervened before I reached the part when I proposed to deal with his latter point. Had he been here at the beginning he would have heard me say that, although I concede that high unemployment might be a factor in causing frustration and difficulty among youngsters, the evidence shows that drug abuse does not necessarily reflect the economic circumstances of an area. It affects the highly educated as well as school drop-outs. It is present in areas of reasonable employment and prosperity and is only now beginning to appear in areas of high unemployment. However, we should not exclude the consideration that the hon. Gentleman mentioned. We should exclude nothing, because the problem is far too serious. However, there is no compelling argument for saying that drug abuse is a direct consequence of unemployment. We are witnessing the product of the greater availability of hard drugs combined with activity by criminal elements, conspiracy against society.
Another but equally important aspect of this terrifying problem is prevention. This, of course, is not the direct responsibility of my hon. Friend's Department, but he will expect me to say something about it—the illicit importation and distribution of addictive drugs must be stopped. In the first instance this is a matter for international co-operation. Secondly, there is a need for the utmost vigilance on the part of customs officers at the points of entry and the police on the streets. Thirdly, we must make an example of the criminal elements who import and push the sale of drugs. Those who are engaged in the destruction of the health and often the lives of young people should, if I had my way, be rooted out and put away for the rest of their lives.
660 It was reassuring to have the view of the Lord Chief Justice last year that long sentences should be imposed for drug trafficking, and the assurance of the Home Secretary that he will introduce legislation during this Parliament: to provide for confiscation of the proceeds of crime. My right hon. Friend told us last December:In some cases traffickers prefer to serve a prison sentence in the knowledge that they can enjoy the fruits of their crime on release. Allowing this to continue would be a mockery of the penalties available.However, we should be under no illusion. There can be no effective crackdown on the drug traffickers unless the law enforcement agencies have the resources to carry out their task. As matters stand, my hon. Friend's Department and the National Health Service must pick up the pieces and meet the costs of cure and rehabilitation. I beg my hon. Friend to urge the Treasury and the Home Office to reinforce the promises with adequate manpower.
Incredibly, until now the trend has been the other way. During the past five years the customs have lost at least 1,000 officers. That is false economy and it is grossly irresponsible to reduce our front-line defences in this way when the problem of drug abuse is growing. Nor is that all. The Metropolitan police drug squad is seriously undermanned. I shall not give the figures, although I know what they are, but I should be surprised if the commissioner were not concerned. Since the Home Secretary is the police authority for the Metropolis, he too should be concerned.
I am strongly in favour of economy in Government expenditure, but not in an area where the savings in manpower are outweighed one thousandfold, if not ten thousandfold, by the social damage and economic cost daily being inflicted by drug abuse on our society. Action must be taken soon, and must be seen to be taken. Meanwhile, the Government can expect constant questioning until it is clear that the dreadful scourge of drug abuse has been brought under control. I look forward eagerly to my hon. Friend's reply.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I very much welcome this debate introduced by my hon. Friend the Member for Castle Point (Sir B. Braine). It reflects his deep and abiding interest in issues of social concern that cut across party lines and political boundaries. A month or so ago I answered a debate introduced by my hon. Friend on the ethics and moral issues surrounding kidney and other organ transplants. That in its turn has prompted a considerable and most useful public debate on the issue.
I hope that this debate will serve to ram home to the people of this country how serious the drug addiction problem is, how rapidly it is growing and the desperate need for all of us—the Home Office, the Department of Health and Social Security and, most important of all, families and society generally—to become gripped of this subject.
My hon. Friend asked me a considerable number of direct questions, which I shall do my best to answer in the time available. If there are any question which I cannot answer before the time at which the debate is due to end, I shall write to my hon. Friend with all the information as soon as possible.
The first point that my hon. Friend raised was on the difficult question of the scale of the problem, and the 661 number of addicts, particularly heroin addicts, in the country. I must be honest. I do not know the exact number, nor do the Government. The reasons must be obvious. It is very difficult to get people to come forward and admit that they are addicts, particularly those who are trading in what is an illegal activity. The only firm figures are the notifications to the Home Office by medical practitioners under the Misuse of Drugs Act 1971. My hon. Friend is right in saying that these show 4,200 new notifications in 1983 which was a terrifying increase of over 50 per cent. on the previous year—and a total overall of 5,100 addicts recorded as receiving notifiable drugs on 31 December 1983.
My hon. Friend is right also in saying that that is a considerable under-estimate of the nature of the problem. Field work experience in London and provincial cities such as Newcastle shows that that is probably an underestimate by a factor of four or five. In 1982, for example, there were 21,600 seizures—twice as many as in 1974. That is a measure of the scale of the problem, although it is only an indirect measure.
What concerns my hon. Friend, the Secretary of State and myself, and the Home Secretary, is not just the growth of the problem or the way in which it is percolating out from the metropolitan centres into smaller towns, and, indeed, into rural areas—there is evidence from East Anglia, Essex and elsewhere of the problem growing in rural areas—but the fact that the problem is hitting increasingly hard lower and lower down the age scale. More and more children, it is reported, are being misused by drug traffickers in this way.
My hon. Friend asked why this should happen. I do not know why it happens. However, it is part of an overall trend of young people misusing a whole range of things. Wherever one looks, one sees that this is a growing problem, whether it is under-age smoking, about which there is great concern, or the misuse of solvents—glue sniffing as it is commonly called. It is all part and parcel of a trend. Sometimes, and tragically, there may be a chain, from smoking, to solvent abuse, to the addiction to soft and then to hard drugs amongst young people. The pushers of these drugs to young people are the scum of contemporary society.
I agree with my hon. Friend's carefully worded views about the overall social picture of hard drug misuse. Some unemployed people are involved, of course, but it cuts across all sorts and types of society. Indeed, in London I have heard one person describe cocaine use as the "Sloane Ranger's" disease. This is not restricted to the poor and under-privileged, and when one considers the sums of money that it costs to purchase heroin on the street that is not surprising. It is alarming to reflect on the fact that the price is coming down yearly, and that the sources of supply seem to be increasing around the world, even though we are doing all that we can, in co-operation with the United Nations and with foreign police forces, to limit the dissemination of drugs in this country.
That is one reason why my right hon. Friend the Secretary of State for Social Services is visiting North America this week. Because he takes a deep personal interest in the topic, he is looking at drug prevention in America in particular, where the problem is much worse 662 than it is here, and heaven forbid that we ever have the problem that exists in America. We must do all that we can to cut it off now.
I deal next with the important topic of prevention, an issue primarily for my right hon. and learned Friend the Secretary of State for the Home Department. That is why I welcome the action that my right hon. and learned Friend is taking to try to stem the flow of drugs from abroad. It is important to recognise in this context that we are increasing the amount of aid that we make available to the United Nations for drug abuse control, in producer countries in particular. I think that the posting of law enforcement officers from this country to Pakistan and the Netherlands in particular is a welcome additional step.
My hon. Friend dealt next with the important and contentious issue of the number of customs and excise officers that are available for control purposes. That is not a matter for me, or, indeed, for my right hon. and learned Friend the Home Secretary, but rather for my right hon. Friend the Chancellor of the Exchequer. None the less, I draw to my hon. Friend's attention the fact that the number of customs officers specialising in, and concentrating on, the prevention of heroin trafficking has been doubled since 1979.
Thirdly, the Association of Chief Police Officers has promised continued high priority for measures directed against drug traffickers, while my right hon. and learned Friend the Home Secretary has also taken steps to control other drugs that may be abused. I cite to my hon. Friend the fact that from 1 April this year Diconal has been added to the list of drugs for which doctors require a special licence to prescribe to addicts.
§ Mr. Patten
No, I shall not give way, if the hon. Gentleman will forgive me. I have only a few minutes in which to reply to the long, complex and important remarks made by my hon. Friend.
I could not agree more with my hon. Friend's support for the view of the Lord Chief Justice that long sentences should normally be imposed for large-scale importation of drugs. This view has been endorsed by my right hon. and learned Friend the Home Secretary and, indeed, he intends to restrict the granting of parole to such offenders. Offenders who calculate that they may make a number of substantial gains, thereafter serve a relatively short prison sentence and possibly get out on parole rather early, will have to re-examine that equation, following the views of the Lord Chief Justice and my right hon. and learned Friend the Home Secretary. Among other measures that he is taking, the Home Secretary has announced that legislation is to be introduced to provide for the confiscation of the proceeds of crime.
There is also the important work, moving more towards the responsibilities of the Department of Health and Social Security, of the Advisory Council on the Misuse of Drugs. This council has a duty to keep under review social problems arising from drug misuse, and, in a concerted view, to advise Ministers on the ways of dealing with them. It has recently submitted to my right hon. and learned Friend the Home Secretary a report on prevention. This will be published shortly, and will be considered carefully by all the Departments involved.
Although the control aspects of prevention which are the responsibility of my right hon. and learned Friend the 663 Home Secretary are a major element in the prevention strategy, action on this front by my Department and other agencies for which my Department has responsibility is also important. I cite as an example the work of the Health Education Council in this context.
The professions have a responsibility as well for the fact that their members have the training that they need. There I take to heart my right hon. Friend's remarks about the perceptions and views of the medical profession and the paramedical professions about drug abuse. Training and education among the professions is perhaps as important as training and information among the general public about the risks and dangers of drug abuse. We shall be giving careful consideration to the implications of the prevention report.
I come finally to what in some ways is the core of what my hon. Friend said. I have in mind his remarks about the need for greater and more adequate treatment. I have some good news for him about the growth of facilities for treatment, albeit that it has happened only recently. But it is happening, and I hope that my hon. Friend will be reassured.
The report about the facilities for treatment which the advisory council submitted in 1982 was very important in this context. The council challenged the traditional tendency to treat specific forms of addiction. Instead, it said that we should try to adopt a broad approach aimed at responding to the range of problems encountered by drug misusers. This is very important. The report listed 80 hospitals in England known to be providing some facilities for the treatment of drug addiction as well as 16 residential rehabilitation establishments for drug misusers and 24 non-residential establishments. But the report highlighted deficiencies in the service.
It is my thesis that the Government have responded in a substantial way to those views of the council. For example, in December 1982 my right hon. Friend the Secretary of State for Social Services announced as an initial response to the report the provision of funds, to be provided centrally, for local organisations to deal with the problem. I put it to my hon. Friend that although we in the House must at all costs take a national view of provision, the nature of drug abuse, the drugs used and the people involved vary so much regionally and locally that the best 664 ways of dealing with them are deeply seated in the local community and trying to draw on the resources of the local community.
§ Mr. Patten
I am grateful for my hon. Friend's assent. Rather than some grand and nationally directed strategy, we have gone for what my civil servants are fond of describing as "the bottom up" approach by going out to the local communities and asking them to put in suggestions for projects. We are making available £6 million over three years, and already about £5 million of that has been allocated to about 80 projects. Examples include the provision of new clinics in Cambridge and Wolverhampton, the strengthening of the North Western regional service and the introduction of new clinics in Newcastle and Kingston upon Thames.
Using the resources of the voluntary sector is also very important. We are helping new advisory and counselling services in Bradford and in Surrey. There is a new residential rehabilitation unit to be helped in Sheffield. There is a telephone advice centre in Birmingham. We are helping a self-help group in Harrow to provide counselling for drug abusers who wish to come off the habit. There it is tranqueliser misusers, because another part of the problem is those who rely on valium, libroxin and other substances, where the help that those tranquilisers gave turns with misuse into abuse. The response to my right hon. Friend's initiative has been most encouraging, and I hope that my hon. Friend the Member for Castle Point will agree that the range of new services that we are providing should go some way towards filling the gaps in services referred to by the advisory council.
My hon. Friend put his finger on the need. We want to make sure that the 14 regional health authorities and, through them, the 192 district health authorities, play their part in this process. We have asked them to report back rapidly about what they propose to do in their own areas to draw together all the resources there are in local community groups to help in this most critical and growing problem.
I can only say that I welcome my hon. Friend's initiation of this debate. I hope that I have gone some way towards reassuring him that in terms of both prevention and treatment the Government are very well aware of this growing problem and that society itself will have to play a fundamental role in contributing toward its solution.