§ 3.30 p.m.
§ The Parliamentary Under Secretary of State, Department of Health (Baroness Cumberlege) rose to move, That this House takes note of the Government's Green Paper, Tackling Drugs Together, and of the health risks of drug abuse, particularly the spread of HIV and AIDS.
§ The noble Baroness said: My Lords, I beg to move the Motion standing in my name on the Order Paper.
§ The Motion is comprehensive and covers aspects of drug misuse which stray into the territory of other departments, including the Home Office. My noble friend Lady Blatch, the Minister at the Home Office, will therefore sum up the debate which I have great pleasure in opening.
§ Drug misuse matters to us all—as parents, grandparents, legislators or opinion formers. It threatens the health and wealth of the nation and damages individuals and their families. Drug misuse can lead to illness—sometimes death —a criminal record, broken relationships, loss of education and job opportunities, and loss of hope.
§ I know that for some parents whether or not their children are misusing drugs is one of their greatest anxieties. For those whose children are involved, the anguish is terrible. Listening to the stories of some of these parents not only engenders compassion but strengthens our determination to do everything in our power to tackle this very difficult problem.
§ Six weeks ago the Government published their Green Paper, Tackling Drugs Together. This set out our strategy to combat drug misuse and its consequences. The Scottish Drugs Task Force, led by my noble and 706 learned friend Lord Fraser of Carmyllie, has also published its recommendations for a more effective and co-ordinated response to the Scottish problem, and similar initiatives are being considered in Wales and Northern Ireland.
§ Drugs pose many risks. One of our main concerns is the risk to public health and it is particularly appropriate that the House should be having this debate today, on World AIDS Day. I should like to pay tribute to the noble Baroness, Lady Masham of Ilton, for suggesting that the House should discuss these important issues today and for her diligence in pursuing action on HIV, AIDS and drugs.
§ The Green Paper contains clear aims to galvanise national and local action. Law enforcement is important but it is only one part of the equation. It is vital to convince people, particularly young people, of the risks involved in drug misuse. The Government believe that the way to tackle drugs is by continuing vigorous law enforcement but with a renewed emphasis on education and prevention. The Green Paper therefore sets out three key objectives. They are: first, to increase the safety of communities from drug related crime; secondly, to reduce the acceptability and availability of drugs to young people; and thirdly, to reduce the health risks and other damage caused by drug misuse.
§ Reducing health risks must be tackled both by dissuading people from misusing drugs and by providing effective services to help those who are. For those who cannot entirely stop, services should be provided which reduce the risks not only to themselves but to others—including, of course, the risks of HIV and AIDS.
§ There is strong evidence that we have been successful in increasing awareness of the HIV-related risks and are also increasingly effective in encouraging those who do inject to adopt safer practices. The report, AIDS and Drug Misuse Update by the Advisory Council on the Misuse of Drugs, published in September last year, includes international comparisons which show that the prevalence of HIV infection among injecting drug misusers is less than 2 per cent. in most of the UK. This compares with 15 to 20 per cent. in Germany and 30 per cent. in the Netherlands. Notable exceptions are in Edinburgh, where a quarter of drug injectors are thought to be HIV-postive—though this is half the level reported in 1986; Dundee, which is slightly higher, 25 per cent. to 30 per cent.; and London where the estimates are on average 8 per cent.
§ Total funding for health services for drug misusers has increased significantly in recent years from £15.5 million four years ago to over £25 million this year of which over £16 million is targeted to reduce the spread of HIV and other blood-borne infections. The aim of these services is to help people to stop taking drugs. But the Government also recognise that for some misusers complete abstinence must be a long-term goal with intermediate stages.
§ Though this evidence suggests that government policies have been effective, there is no room for complacency and the Government have reaffirmed in the Green Paper the importance of drug treatment services. We have also set a target in the Health of the 707 Nation to reduce the percentage of injecting drug misusers who report sharing needles in the previous four weeks.
§ The Green Paper commits the Government to several new initiatives which not only combat drug misuse but protect the public health. Major steps include: the launch of a national drugs helpline to be run by staff with a good knowledge of drug misuse. They will be able to refer those who need help to appropriate agencies and give advice and support to others who seek information or who are worried and anxious. The helpline will be available from April next year.
§ The Department of Health will also be co-ordinating a new publicity strategy. It will focus on reducing the acceptability of drugs, especially among young people. It will involve young people themselves, to put across the message to others of their own age in terms they understand and believe. We recently saw just how effective this strategy can be when the department ran a video competition for schools, focusing on drug and other substance misuse which attracted nearly 2,000 entries. We shall also use the expertise of those outside government in advertising and the media who can help us get the message across. And we will encourage partnerships with the private sector for sponsorship and commitment to tackle this miserable problem.
§ Lastly, the department will ensure that drug misusers have easy access to cost effective and appropriate services. This is crucial in tackling risks to public health.
§ This is a big financial investment and we are determined to ensure that all the resources spent deliver tangible results. Good intentions are not enough. That is why we launched a major review of the effectiveness of drug treatment services in April this year. It is being conducted by a task force, chaired by the Reverend Dr. John Polkinghorne, which will report to Ministers in early 1996. Its remit is to ensure that treatment services work to clear objectives, and that an assessment can be made of how effective they are.
§ The task force has already commissioned a "mapping" survey of current services and has invited those in the field to say what works and what does not. The task force has already received an encouraging 100 responses. A major study of treatment outcomes will also begin in early 1995. This is breaking new ground, for it will be the first time that such a comprehensive review has been undertaken.
§ The Green Paper makes clear that the Government will continue to encourage a range of initiatives which have a proven track record. This includes needle exchange schemes, which are particularly important in combating the spread of HIV and other blood-borne diseases such as hepatitis. I saw for myself how effective such schemes can be when I visited the Angel Drug Project in Liverpool Road, which offers an impressive programme of care.
§ Of course not all drug misusers are in touch with services. We need to reach them, too. That is why the Government fund health authorities to develop projects which go out to make contact with people in the streets, 708 in their clubs, pubs and homes, to persuade them away from high risk activity and encourage them to seek help and advice.
§ There is also a need to encourage drug misusers to adopt safer sexual practices. The department will be making available the results of an exploratory study by AVERT on safer sex education for drug misusers.
§ Another important means of discouraging injecting drug misuse and the spread of HIV is the substitute prescribing of oral methadone. I know it is a controversial area but the Government have accepted the advice of the Advisory Council on the Misuse of Drugs that the benefits of oral methadone have been demonstrated; but with the important proviso that the prescribing of methadone alone is unlikely to reduce substantially drug use, injecting, and risky sexual behaviour.
§ That is why the Government have accepted the need to set up structured oral methadone maintenance programmes on a pilot basis. A number of studies will start in January, involving between 300 and 400 drug misusers, and will be funded for 12 months. A shortlist of those wishing to take part is being drawn up and announcements on the successful schemes will be made before Christmas. The studies will be independently evaluated and the results will be fed into the work of the task force.
§ So we are tackling drug misuse on many fronts, recognising that it is a large and growing problem. We are faced with an increase in experimentation by young people, an increase in new addicts, more misuse and, sadly, deaths. All this means a real increase in human misery. The Green Paper is a unique opportunity to meet the challenge and tackle this threat.
§ The Government are particularly concerned by the number of young people who misuse drugs—as is every parent in the country. A recent British crime survey suggests that nearly a third of young people between the ages of 16 and 29 have taken an illegal drug. And, worryingly, 14 per cent. of school children aged 14 and 15 admit to taking an illegal drug. Young people need to be better informed about the risks of drug misuse so that they can resist pressure, whether from their own friends, brothers or sisters or anyone else.
§ Education must be one of the keys to success. That is why my right honourable friend the Secretary of State for Education has launched several new initiatives which will play a major part in the Government's drugs strategy. These include: new support for training teachers in drug education, and the funding of innovative projects around the country to test different approaches; publication on 8th November of a draft circular for consultation. This contains guidance for schools on the dangers of substance misuse, including solvent, alcohol and tobacco. It also contains advice on the development of school policies on drugs education, and on how to deal with drug-related incidents on school premises; the development of guidance on different ways of teaching about drugs within the national curriculum; the production of a digest of teaching materials to help schools to select those which best suit their needs; and the Department for Education is also organising a series of regional conferences in the New 709 Year chaired by the noble Earl, Lord Russell. They will raise awareness of drug issues, stimulate debate at local level, and promote activity.
§ The Green Paper is called Tackling Drugs Together because we recognise that a co-ordinated approach is vital at both national and local level. At national level the Home Office, the Department of Health, the Department for Education and H.M. Customs and Excise all have key roles to play. But the problems cannot be tackled by central government alone. At the local level teachers, the police, health professionals, parents and carers, social services, the probation service, the prison service, voluntary agencies and many others need to work together to maximise our efforts in dealing with this tragic problem that still claims too many victims through experimentation, dependency and crime.
§ It is possible for local people, working together, to make a real impact on local problems. For example, the East Sussex Drugs Advisory Council has, with the support of the drugs prevention initiative, responded to the worrying problem of drug use in the rural areas of the county.
§ First, it undertook research which showed that drug use was common to many young people, whether they lived in rural or urban communities. Information and advice for these young people were clearly needed as a matter of urgency; but the population was scattered over a wide area. How could a confidential accessible service be provided? How could young people be attracted, without ringing alarm bells in the whole community?
§ The solution was a youth outreach minibus. The scheme was piloted in Woodingdean. Young people themselves were involved in the management committee. In its first 10 months, the bus operated for three nights a week, for 2½ hours at a time, and 309 people made contact. Those people went on to contact the bus on a further 539 occasions. Most of the contacts were boys aged 13 to 16 and girls aged 14 to 16; but 78 adults also sought advice. The most requested subject for information was drugs. There were 1,179 inquiries about different drugs on 504 occasions. The youth advice and information bus continues to visit sites in Woodingdean, Ovingdean, Rottingdean and Saltdean, and is into its third year of operation.
§ The Government need to build on good work like this and we welcome the advice and comments of those already working in the field. Our consultation period runs until 20th January and the results will inform the White Paper to be published in the spring.
§ To underpin and strengthen local efforts the Government have proposed setting up over 100 Drug Action Teams. The teams will be set up by chief executives of district health authorities and will be 'composed of key people who can make things happen locally. They will be advised by reference groups drawing on a wider range of local interests.
§ District health authorities will be asked to report to central government on the setting up of teams by 30th September next year. The chair of each team—selected by the team members—will report to the Lord President of the Council, my right honourable friend Tony 710 Newton, who chairs the ministerial sub-committee of the Cabinet on drug misuse. The Government intend to make available £8.5 million to provide support for these teams over the three years of the strategy.
§ Members of voluntary organisations will be influential in the part they play on the reference groups and they will draw on the work they do in providing expert advice, treatment and rehabilitation to drug misusers. Probably the largest and best known charity in the field is Turning Point, which has nearly 50 projects delivering a range of services to over 14,000 people a year. The voluntary sector makes a remarkable contribution not only to tackling drug misuse but also to combating HIV and to caring for those infected. Organisations like ACET and Barnardos, for example, are reaching young people in schools, and are very impressive in the work that they do.
§ I have concentrated on the need to reduce the acceptability of drugs, especially to young people and on the health risks associated with misuse. But the Green Paper also underlines the need to reduce the availability of drugs and to improve the safety of communities from drug related crime. These are issues for which the Home Office has prime responsibility and my noble friend Lady Blatch, in closing the debate, will expand on initiatives being undertaken in these areas.
§ In conclusion, I cannot pretend that there are easy or quick answers to this problem. But I am confident that our new strategy is an important step forward. The Government are determined to ensure that the resources we are investing are used effectively, measured against clear outcomes, and monitored. The strategy provides a clear framework for this.
§ In taking all these tasks forward at national level we will never forget that we are not just talking about statistics but about individuals, their families and the communities in which they live and work. Lives have been blighted, indeed even ended, by the misery and waste that drug misuse can cause. We owe it to them to make tackling drugs together a reality. I look forward to your Lordships' debate and to my noble friend's concluding remarks. I commend the Motion to the House.
§ Moved, That this House takes note of the Government's Green Paper, Tackling Drugs Together, and of the health risks of drug abuse, particularly the spread of HIV and AIDS.—(Baroness Cumberlege.)
The Earl of Dudley
My Lords, before my noble friend sits down, will she confirm that her speech and her references to methadone did not hint at an intention by the Government to restrict the prescription and controlled use of methadone as a heroin substitute?
§ Baroness Cumberlege
My Lords, we are trying to take it forward in these pilot areas so that we have firm evidence as to the impact that methadone can have in combating this problem.
§ 3.48 p.m.
§ Baroness Jay of Paddington
My Lords, I am grateful to the Minister for introducing this debate on the Green Paper Tackling Drugs Together and, very 711 importantly, for giving us the opportunity to discuss HIV and AIDS on World AIDS Day. December 1st has now become a traditional moment to reflect on the global pandemic and to look at the situation in Britain and our own strategies for prevention and care.
The World Health Organisation has today reminded us that in the past year more people have been infected with the HIV virus and more people have died than in any previous year. There are now 6,000 new infections every day. The World Health Organisation predicts that 40 million people will be HIV-positive by the end of the decade. Already 1 million children are infected, and by the year 2000 there will be 10 million so-called AIDS orphans.
Today, in Paris, there is a world summit of government Ministers—I understand that the British Government are represented by the right honourable Mrs. Bottomley, the Secretary of State for Health—which will sign a series of agreements to improve international co-operation on AIDS. One of those agreements is to make clean needles universally available to injecting drugs misusers. I suspect that, like all attempts at prevention, it is likely to be more vigorously pursued in the industrial world than in the poorer countries, where all resources, including for that kind of programme, are very scarce. On the agenda in Paris is an attempt to redress the balance of the resources for AIDS prevention, so that more money and more skills can be deployed in the countries of Africa, Asia and South America, where whole populations are now threatened.
On World AIDS Day we may indeed justifiably congratulate ourselves in Britain on our success in keeping levels of infection fairly low. Just over 22,000 HIV-positives are officially reported in this country compared with 10 million in sub-Saharan Africa. But, particularly today, we cannot ignore the global crisis and our responsibility to try to help. AIDS and the Family is today's international theme; the family of man is certainly facing a terrifying health threat, the scale of which is unique in modern history.
In this country the prevention strategies adopted in the mid-1980s have been relatively effective. Today, for example, there are more AIDS cases in Paris than in the whole of Britain. But, although the number of people infected in the past year through sexual intercourse has risen and the percentage of those infected heterosexually has now reached a substantial 28 per cent., and although drugs use is increasing, the number of infected drugs users seems to have stabilised. The continuing message about that, as the Minister has already emphasised, is that, although the overall picture is somewhat 'encouraging, we must continue to say, "No complacency". A successful prevention programme is not like a successful vaccine: one shot and it is all over. Health education and other measures must be constantly repeated, constantly reviewed and constantly renewed. It is in that context that Tackling Drugs Together has been generally, if not particularly enthusiastically, welcomed.
712 Many of those working in the drugs field are pleased that the document recognises the value of a co-ordinated strategy and acknowledges the growing pressure on local communities by establishing drug action teams in every district health authority in England. The Minister outlined an extensive programme; but, as so often in health and social services, there is grave concern among those working in the field about the potential gap between a paper policy and practical reality. In other words, where are the resources to make it all work?
Yesterday we had a very interesting and rather disturbing debate, in which many noble Lords who are present today took part, about the funding crisis which already exists in community care. It seems that many of the proposals in the Green Paper on drugs will again fall on the overburdened local authorities. We know that ring-fenced money for HIV and AIDS is to be phased out. It is difficult to see from where the new money for new services and new programmes will come. Although the Minister's speech paid tribute to the voluntary sector, in this context it is unfortunate that the Green Paper pays scant attention to the role of the voluntary sector and volunteer action. Small community groups and national groups, such as the already mentioned Turning Point, have played a leading role in the fight against AIDS. They have the credibility and often the kind of information and support that is more acceptable to drugs misusers than is the statutory sector. It is vital that they are equal partners in any drugs strategy and any AIDS strategy and that they are properly resourced to do their own work.
There are also concerns about the proposals for general health promotion campaigns and education in schools. As your Lordships know, the Health Education Authority, which has done extraordinarily useful work in this area, remains under a very peculiar political cloud. Its future still seems very uncertain. It would be interesting to know whether the Department of Health, or even perhaps the Department for Education, now intends directly to manage some of those programmes. I am pleased that the Department for Education will offer new resources to schools through the GEST schools programme. But those programmes will have to be very sensitively introduced, particularly to those teachers who feel somewhat scarred and burned by all the furore in the past few years about sex education and the removal of HIV and AIDS from the national science curriculum.
Many teachers are now extremely wary of the whole area of personal and social education. The climate, which a few years ago produced helpful, open discussion in schools and clear direct information for pupils, has changed. It has changed because the policy messages from Ministers have frankly been inhibiting and regressive. Perhaps the climate has now changed again and perhaps the Green Paper signals another change. But any new initiatives which try to introduce new programmes on drugs and health will need very careful nurturing to be successfully launched.
I welcome this opportunity for a World AIDS Day debate. But frankly I am a little surprised that the Government have linked the introduction of the Green Paper to the issues of HIV and AIDS. I understand from 713 the Minister's remarks that the noble Baroness, Lady Masham of Ilion, whose work in this field we all know and respect, may have been influential in this matter. But it seems to me that the Green Paper's dominant theme is much more concerned about law and order than about public health. That is perhaps not surprising when the Government spend twice as much on control and enforcement as they do on prevention and treatment.
My noble friend Lady Mallalieu will focus later in the debate on some of the specific enforcement issues. I would simply suggest that the overall law and order tone of parts of the Green Paper seems to distort some of the health objectives and may even work against some of the successful work on drugs that the Department of Health itself previously supported and promoted. Time and again, despite what the Minister said, the Green Paper underlines the ambition of total abstinence for drugs misusers. Nowhere in the Green Paper is harm reduction explored as a suitable goal. Yet, all the evidence suggests that it has been the effective programme of harm reduction, through needle exchanges, substitute prescribing and education on safer drug use and safer sex, that has produced the stable HIV infection rate of which we are now rightly proud. As we know, harm reduction methods are complicated and expensive, but they have been successful.
If now the loudest theme from central government is the notorious American "Just say no", local health and social services authorities, battling with severe financial problems already, may well be less enthusiastic about delivering balanced interventions that can help serious drug misusers achieve stability. As the Minister said, two years ago the Health of the Nation, as part of the general HIV and AIDS policy, set the very ambitious target of reducing injecting drug use by 50 per cent. by 1997 and a further 50 per cent. by the year 2000; in other words, wiping it out altogether by the end of the decade.
The Health of the Nation handbook on action for HIV and AIDS in sexual health set out in a very detailed and constructive way programmes for at least trying to achieve that very ambitious target. Most of the proposals included there were rooted in harm reduction and education. The action points contain every type of proposal, ranging from the national to the very local, and are based on the idea that it is not very difficult to achieve total abstinence for most drugs misusers. The same messages run through the latest report from the Advisory Council on the Misuse of Drugs (ACMD) working party on AIDS and drugs misuse.
The working party again pays tribute to the success of comprehensive harm reduction and suggests extensions, including, significantly, a great deal more outreach work. The Minister has already mentioned the oral methodone programme. Despite the intervention from her own Benches, I hope that the Government will not shy away from extending the programme of a structured strategy, about which the AIDS and Drugs Misuse Update says:The benefits both in terms of individual and public health have now been clearly demonstrated714 Both those documents—the AIDS and Drugs Misuse Update and The Health of the Nation handbook—seem to reaffirm the basic tenets of the drugs and AIDS programme in this country far more strongly than the new Green Paper does.
The Earl of Dudley
My Lords, I hope the noble Baroness will forgive me for intervening. I believe she misunderstood the purport and tenor of my question. I was anxious to ensure that no restriction was placed on the use and prescription of methadone in the health service as a heroin substitute. It can be a useful aid both in the prevention of heroin addiction and of crimes arising from heroin addiction.
§ Baroness Jay of Paddington
My Lords, I apologise to the noble Earl. Indeed I did misunderstand him. In an effective way he was perhaps using a double negative, which I misunderstood. I repeat that I entirely agree with the ACMD report that the benefits have now been clearly demonstrated. I am glad that he too supports that view. I apologise to him for that misunderstanding.
The Green Paper does not reaffirm in quite the same strong way, as do the documents to which I have just referred and the previous document on the health of the nation, the basic tenets of the AIDS and drugs programme which have been so successful. I hope that by presenting the Green Paper the noble Baroness, Lady Cumberlege—who was very much in the forefront of these programmes—is not lending the Department of Health's authority to an approach which seems to be based far more on control and punishment than on public health.
AIDS prevention and treatment in this country has always been based on open access and non-discrimination. That has been particularly valued by drugs misusers who often felt stigmatised and ostracised by care services. On World AIDS Day it is important that we remember the significance of human rights in the AIDS battle. I shall conclude by quoting Dr. Jonathan Mann, who is the founding director of the WHO global programme on AIDS. In a recent speech he said:We must recognise that across the world it is discrimination, denial and the abuse of human rights which is the major risk factor. We must adopt strategies that recognise this, otherwise we will lose the coherence and credibility of the global fight against AIDS".I very much hope that that philosophy will be in the White Paper which, in the spring, takes forward Tackling Drugs Together.
§ 4.2 p.m.
§ Lord Addington
My Lords, the Green Paper contains one theme which must be recognised immediately. It takes on the idea of horizontal integration of responsibility for a wide social problem in a practical way. It is signed by five senior members of government, including three Secretaries of State. The document deals at all levels with horizontal integration of authority for the problem. It is probably the one theme that runs through the document upon which we can congratulate the Government. It does not try to pigeon-hole treatment of the problem to one specific area. As the noble Baroness, Lady Jay, said, it places 715 most emphasis on criminal activity, at least in the first part. At page 10 of the document, paragraph 1.6, under the heading "Crime", the Government's main objectives are,to see that the law is effectively enforced, especially against those involved in the supply and trafficking of illegal drugs; to reduce the incidence of drug-related crime; to reduce the public's fear of drug-related crime; and to reduce the level of drug misuse in prisons".Laudable as those aims are, I am afraid that we can do little more than put a brake on the flow of drugs and the activity of those who are using them in our society. We are not a police state and I hope that we shall not become one. We have open borders and these substances will make their way into our country. Indeed, many of the synthetic drugs are produced here and we export them. There is a real problem in this country. We cannot stop the drugs becoming available. It is therefore commendable that the Government talk of education. However, when they do so they are faced with the problem that they will not be believed. They put forward a clever and simple message about drugs misuse; but even so people will rebel, especially the young. The young will always rebel against advice, no matter how sensible it is.
The dabbling in, and experimentation with, drugs and substances has always gone on. Indeed, one need only look at the use of alcohol in our society and the amount of under-age drinking that takes place to realise that there is always a mystique about these things. The fact that what we are discussing are new substances will not stop them becoming available. The Government therefore find themselves in the position of having to control the input of drugs and dealing in the strongest possible way with those who supply them while in fact not being in a position to control the situation.
We talk of control and the effective use of drugs in prisons. In our society it is only in a prison environment that there is containment and the legal authority to control the amount of drugs being used. But even inside prisons we have failed. It may be possible to tighten up the situation but I doubt whether, in any circumstances, we shall ever be able to stop the misuse of drugs in prison.
Bearing that in mind, will we ever be able to stop the misuse of drugs in our society? The answer is no. When discussing the problem we must bear in mind also that if we can make drug misuse less socially acceptable to the general public, the problem will grow more slowly. Drugs tend to appear in fashion waves, as does everything else. Thus we may drive back certain types of drugs and banned substances. Indeed, we have seen one such success in our society; that is, the cutting back of tobacco. That was not achieved by making it a 'prescribed drug but through social pressure, and we have actually cut down its use.
It may be possible to create the same effect with illegal drugs and substances. But they may be replaced in other ways. Education can only be a long-term process. A reinforced message will still be ignored at times by certain people. But through education we can integrate further the fight against crime relating to drugs 716 misuse. We may once again put a series of brakes on the process but we shall never be able to stop the integration of drugs into our society.
The Government should perhaps have placed more emphasis on rehabilitation—as we do with criminals—of those who have started experimenting with banned substances. If we can convert people from continuing a habit, we shall cut down the market for the drugs which will ultimately reduce the supply.
The noble Earl, Lord Dudley, who, unfortunately, is not in his place, said that if we can provide a legal and controlled substitute for certain categories of drug, we shall stop part of the upward spiral of misuse and availability of drugs. In the Green Paper the Government mention on numerous occasions those types of activity. But if they want to make an effective inroad into the problem they will have to put far more emphasis on that area.
The linkage between the spread of the HIV virus and drugs, as the noble Baroness, Lady Jay, said, is primarily the sharing of needles. Basically we are talking about the transference of infected body fluids. Thus when we talk about the spread of this killer virus, we must also talk about our attitudes towards sex education and relate the two. Over the past couple of years we have had a series of stormy debates in this Chamber on the subject. If I stand back from any party political stance, I believe that we saw a series of over-reactions to political correctness in certain handbooks and to specific interest groups, and we heard many justifiable moral stances. In the end we backed down from a sensible position which was being abused by a few. I hope that the Government will be encouraged to re-establish their position of providing as much knowledge as is necessary and as much knowledge as a child can take on board and that they will do so without providing the moral judgments that go with it. Indeed, I was forced to admit that certain articles which I read out in the Chamber were not for the consumption of people below the age of 12.
A storm was also raised about articles designed for teachers giving them answers to questions that were to be asked. In a recent case questions about certain sexual practices were put by a child to a nurse giving information on this subject and the teachers supported the nurse who answered the questions correctly. She said that certain sexual practices can lead to the transfer of the virus. If we can re-establish that publicly as the Government's position we will be helping everyone because we will know what we are allowed to do and what we are not allowed to do in the classroom. If that is taken on board we will be able to transfer information. In addition, as anyone who has ever tried to get across any message knows, one can reinforce types of information by linking them to other types of information—the horizontal integration of knowledge. We shall be able to reinforce both types of message.
When dealing with a subject of this complexity the Government are very much to be congratulated on having done something here which we have criticised them very often for not doing in the past. They have given a series of initiatives which will be assessed over a period of time. The new local health authority-led action 717 groups will be able to provide incentives. They will also be able to respond to vocal problems. I have not mentioned the fact that certain urban environments have led to pockets of very high drug misuse. Badly designed council estates provide lots of dark corners with lots of easy access and a good environment for crime generally and drug-related crime in particular. Once crime is flourishing, prostitution will also flourish, which can lead to the transfer of the HIV virus.
There are many good things in this document. There are no big ideas, probably because they have all been tried and many of them have failed, but the Government are at least initially taking on board the fact that there is a multiplicity of problems connected with this one area. I hope that the document will lead to a growth in more consultative and positive work in this area.
§ 4.13 p.m.
§ Lord Kilmarnock
My Lords, I must start by apologising to the House for behaviour which I dislike in principle. I am booked on a plane to Barcelona this evening for a pre-arranged meeting with members of the regional government of Catalonia to discuss their AIDS strategy and a conference that we are holding there next year with their support. Therefore, I am afraid that I shall not be able to stay for the end of the debate. I realise that this will probably forfeit a reply from the noble Baroness, Lady Blatch, to specific points that I shall raise, but I hope they will be given some consideration as part of the consultation process.
It is clear from the lucid speech of the noble Baroness, Lady Cumberlege, and from the document itself that the Government have devised a comprehensive interdepartmental strategy on which they are to be congratulated. I am glad, on behalf of my colleagues on the all-party parliamentary group on AIDS, that the Motion refers specifically to the spread of HIV and AIDS. Clearly, there is a much bigger AIDS debate than is contained in the Motion and a much bigger drugs debate than is contained in AIDS alone. All the same, it is doubly appropriate that HIV infection and the AIDS syndrome should receive some prominence today, it being World AIDS Day, the seventh in line since it was initiated in 1988. It is also today, as the noble Baroness, Lady Jay, said, that the AIDS summit hosted by the French Government is being held in Paris, where our own Secretary of State, Mrs. Bottomley, is representing this country right now.
Again following the noble Baroness, Lady Jay, I want very briefly to pursue the World AIDS Day theme before turning to the substance of the Motion. The British Government have an excellent record on AIDS control, treatment and prevention, but there is always the danger of this flaking at the edges, particularly as. regards government relations with and use of the skills of the voluntary sector. I shall return to that point. The Government should not listen to siren voices, within their own party or without, that it was all a fuss about nothing, or is all over bar the shouting. The fact that we have just crossed the threshold of 10,000 AIDS cases, about two-thirds of whom have died—many in the most distressing circumstances—should give us pause for thought in two directions. First, the fact that the death 718 roll is much less than the upper bracket of early predictions is a matter for congratulation rather than for carping or scaremongering, as I think the noble Baroness, Lady Jay, also said. Epidemiology proceeds through a series of refinements based on methodological improvements and lengthening experience. British predictions are now among the most accurate in the world with great benefit to public policy and planning. The relatively low prevalence rates compared with those of most other member states of the European Union are a tribute to prompt and effective government and voluntary sector action, working hand in hand —an advantage that should on no account be lightly surrendered.
The second thought triggered by our 10,000 cumulative AIDS cases is one of immense sadness that a condition which affects mainly the young and those in prime of life should have reached the proportions that it has. In this country public health and private prudence have built a formidable alliance against it. Yet, the results are still devastating for all those infected or affected by it. That is why we have World AIDS Day. The red ribbon that I am wearing is not some kind of trendy, leftish logo, or I would not be wearing it; nor, I suspect, would some other Members of your Lordships' House who are wearing it today. It is a symbol of solidarity with many people across the world who are faced not only with a devastating disease but one that too often falls on the wrong side of socially acceptable diseases. With this we should have no truck.
Now to the Motion. The consultation document, as I suggested earlier, is rather impressive in its cross-departmental scope, but that inevitably makes it somewhat hybrid. Where departmental interests conflict, how will these be sorted out? Chapter 3, paragraph 3.58 recapitulates the target in the health strategy document The Health of the Nation to reduce the percentage of injecting drug misusers who share needles from 20 per cent. in 1990 to 10 per cent. by 1997 and 5 per cent. by the year 2000. These are very concrete aspirations. How are they to be achieved? Abstinence is adopted on page 12 as the "ultimate aim", but it is recognised rightly that exhortation is not enough and that the Department of Health should ensure that drug misusers have,easy access to cost-effective and appropriate services".In effect, what is sometimes called "harm reduction", as mentioned by the noble Baroness, Lady Jay, or what we might equally dub "damage limitation", have to be brought into play as part of a dual strategy. In paragraph 7.3 it is stated that the success in limiting the number of infections among drug misusers must be sustained and paragraph 7.14 commits the Department of Health to encourage,a range of initiatives which minimise the risks and damage of drug misuse … to individuals who are not drug free, eg syringe and needle exchange schemes and advice on safer sex".I am happy with most of the above, perhaps a little happier than the noble Baroness, Lady Jay. I am concerned with public health and it looks to me as though these passages were written by the Department of Health. But I ask myself how its aims are to be achieved. Paragraph 3.59 speaks of more than 300 needle and syringe exchange schemes which have been 719 set up since the mid-1980s via pharmacies and other agencies, and on the next page I look at the graph that tells me that HIV infection through equipment sharing has come down from a high peak in the mid-1980s to a much lower plateau today.
I draw the conclusion that the exchange schemes have been a great success and I believe that that was acknowledged by the noble Baroness, Lady Cumberlege. But when I turn to the passages on policing in Chapter 5, I find no mention of them. I read that the chief constables are asked to consider,establishing formal drugs strategies for their forcesand to report their findings to the Home Secretary by the end of June 1995. There is an aim to establish a "national strategy". We are presumably a long way short of a national police force to which I would be totally opposed. But I do ask myself whether the new strategy will leave enough flexibility for force-by-force tactical decisions on the handling of the drug scene. The epicentres of drug misuse are bound to be different from the rest of the country. Needle exchange schemes such as that on Merseyside, which has been a great success—and there have been others—must depend to some extent on sensitive policing. I would like to be assured that they will not be affected adversely by the new strategy.
None of this is nit-picking. It goes back to our record of achievement and whether we can afford to relax our guard. I would suggest not. Across the European Union some 40 per cent. of AIDS cases are caused by intravenous drug misuse. In Spain generally and Madrid in particular, that figure is in the region of 60 per cent. to 70 per cent. of a higher per capita total than we have here. In our country the equivalent figure appears to have flattened out at about 8 per cent. or 9 per cent. But the word is "plateau" and the only right direction is further downward still.
I shall not say very much about prisons because others will speak with much more authority than I can in this area. I do however have some concern about how compulsory drug testing through urine will sit with the recent conversion of the old prison medical service into a Directorate of Health Care with a mission to provide better health care to prisoners. If a lot of addictions are discovered by this method, how will they be treated? Also it is hard to see how this policy would be compatible with the distribution of bleach, which was the response—correct in my view—of the governor of Glenochil Prison in Scotland following the discovery last year that at least eight and up to 13 prisoners were HIV-positive through needle sharing while in prison.
Another section of the document that drew my 'attention is Chapter 10, particularly the paragraphs on purchasing criteria and a voice for service providers. Now, I am not one of those who are bitterly opposed to the so-called "contract culture". I can see virtues in clear contracts to perform services, so I was glad to read the objective in paragraph 10.8 to,improve contracting arrangements (for both purchasers and providers)720 because there is a very real problem here. It is essential that public purchasing authorities agree and stick to viable schedules of payment when entering into contracts with voluntary sector or other providers, but particularly with voluntary bodies which often experience severe cashflow difficulties. I was therefore encouraged by Mr. Tom Sackville's Written Answer on 24th November to a Question in another place that,The National Health Service Executive issued a requirement to health authorities on 28 October 1994 to comply with the Confederation of British Industry prompt payment code".I hope that this will become standard good practice throughout the public sector, including local authorities, otherwise the contract culture will indeed fall into disrepute and become inoperable.
My final point is of a more general nature. On reading the document I was struck, like the noble Baroness, Lady Jay, by the rather minimal role allocated to the voluntary sector. The proposed drug action teams to which the noble Baroness, Lady Cumberlege, referred, in paragraph 8.9 on page 59, have no voluntary sector representative at all, as noted critically by Turning Point, the largest UK charity in the field, in its response to the Green Paper. Even for the rather larger and presumably merely advisory drug reference group whose suggested composition appears on page 64, only one or possibly two voluntary representatives are proposed out of a total of about 20, despite the noble Baroness's endorsement of their importance. There is mention of SCODA in paragraphs 10.10 to 10.12 as the umbrella body for service providers, but the impression given is that it will become increasingly an arm of government.
Obviously, this is a government-led initiative and rightly so, but no tools or weapons should be neglected wherever they are to be found. For instance, voluntary bodies working in the HIV-AIDS field have performed, and are performing, work of incalculable value. By analogy it makes sense to make the maximum use, across the whole field of drug abuse and prisons, of voluntary sector agencies which can operate so effectively in the interstices of public policy.
The word "together" appears in the largest print on the cover of this document, referring presumably to the five sponsoring government departments. I believe that the Government would be wise to extend its scope more widely to build in more positively and actively national voluntary bodies with all their accumulated expertise and commitment in the field and local community-based organisations. That could be done for a tiny proportion of the £526 million spent on drugs by the Government last year. Only then will the word "together" achieve its full potential.
§ 4.26 p.m.
§ Lord Mancroft
My Lords, I welcome this opportunity to debate this Green Paper and indeed I welcome the Green Paper itself. It is—and I believe other noble Lords have already made the point —quite a remarkable document in many ways. Apart from the fact that it is 114-pages long, as the noble Lord, Lord Addington, pointed out, it has been signed by three Secretaries of State and the Paymaster General. Heading the list is the Lord President of the Council and it has 721 an introduction by no less a figure than the Prime Minister. I have looked at the document quite carefully. It is arguably the most extensive policy document which has ever been produced by a European government on the subject of drugs, and congratulations are therefore due both to the Prime Minister and the Government for having taken the trouble to produce it.
Reading my right honourable friend's introduction and the whole foreword to the document, I can only conclude that the concern which various Members of your Lordships' House and others have voiced about the drug problem in Britain over the past few years has finally registered with Government. I see this document as a statement by them that they have finally realised the extent and the serious nature of Britain's drug problems and that they are going now to do their level best firmly to grip this problem. It may not have escaped the attention of some of your Lordships that I have on occasions been slightly critical of the Government's policy in the past. I shall return to the offensive quite soon. But before I do so it is important to register very loudly and clearly that this is a tremendous step forward for any government to take. I believe that it is the first time that any European government, as I have said, has attempted to do that.
On the plus side, this Green Paper contains a really thorough and deep review of the present state of affairs relating to the drug problems in this country and what steps the Government at all levels have taken until now. It quite rightly acknowledges that there are many gaps in the information which we need in order to make the kinds of decisions that we would like to make, and that there are gaps in the services which exist at present. The document quite rightly outlines proposals to deal with them. It has also to be said that a great many of the 114 pages are taken up with telling us things that we already know. The foreword states,We need a co-ordinated and clearly focused domestic strategy".The document goes on to say:We recognise that the strategy is only as good as its delivery".That is all well and good and I believe that we all agree with that. It could of course apply to practically every government policy and every government department. Of course there are matters with which we shall agree and there will be others with which we shall not agree. It is probably not very helpful to go through all 114 pages picking out the parts which are good and the parts which are bad. It is important to try to look at the paper from a wide point of view and to see what is the overall strategy; what is the direction we are going to take and whether that is a good direction in which to be going. It is clearly on that that we are being invited to comment.
Roughly speaking, there are really only two ways in which one can deal with the drug problem. One can seek either to control the supply of drugs, using Customs, the police, courts and prison—that is to say, the criminal justice system—or one can seek to control the demand. There are two ways of doing the latter. The first is through education and prevention, and the other is through treatment of the existing addict population.
Historically in Britain the emphasis has been on trying to control supply via the criminal justice system, but over the past few years—this is no criticism of that 722 system—it has become increasingly clear that that system does not really work. Although in the Green Paper the Government reiterate their commitment to trying to control the supply of drugs through the criminal justice system, it seems to me that the emphasis is switching. I accept that the noble Baroness, Lady Jay, does not agree, but I have more information on this than the noble Baroness. There does not appear to be quite so much to say about the criminal justice system as there used to be. It seems that the Government realise that however important it is, it is not going to be the answer, so the emphasis has switched to the other side of the coin—that is, to reducing demand, which means education and prevention on the one hand, and treatment on the other.
Looking at the Green Paper, it seems that the Government have opted for the route of education as the means of prevention. The immediate question is: why that route and not the other? I think that it is for a very simple reason. I refer to the lovely old English proverb, "Prevention is better than cure". I have two reasons for thinking that that might be the philosophy behind the policy. The first is that my right honourable friend the Secretary of State for Health said that to me rather forcefully at a meeting some time ago. My second reason is that that phrase occurs in the Scottish version of the Green Paper although I could not find it in the English version. It is a marvellous idea. It is much better not to go out and get wet than it is to sit in bed with a streaming cold. It is better not to break your leg than to put a plaster cast on it. Clearly, prevention is better than cure—but only if it works; only if we can identify some factor or something that we can say or do that will actually persuade people not to start using drugs.
The present aims, as outlined in the Green Paper, and the policy that we are following as we speak at the moment, comprise three aspects. The first is education and the youth service, and that includes the work in the national curriculum. The second aspect is the Home Office drug prevention initiative, and the third element comprises the national information and advertising campaigns, including European Drug Prevention Week.
The aims that are set out in the Green Paper are to discourage young people from taking drugs and to develop effective education strategies focusing particularly on young people. I am not absolutely certain of the difference between the two. They seem to be exactly the same. Pages 47 and 48 contain a further list of five or six things saying basically the same thing, "We're going to try to educate kids. We're going to try to help teachers to educate kids. We're going to get into schools. We're going to do youth projects". All are saying the same: that the Government will develop effective education strategies focusing particularly on young people.
In other words, the existing strategy for education and the proposed strategy for education are very much the same thing. That does not matter very much because it is fine if it works. Furthermore, performance indicators will be built into the new strategy. That is a first and we should welcome it. The big question is: can it work? My noble friend Lady Cumberlege has talked about our track record, so I ask again: can the policy work? Well, 723 we have had the policies that are outlined in the Green Paper to a much lesser extent for four, five or 10 years—certainly, for as long as I can remember—and during that time drug use among young people has increased. This is a difficult issue.
As I think that this is an important subject, I have spent the past year looking, in my amateur way, at studies of drug education in schools. I have not found a single example of a study anywhere in the world to demonstrate that if you put a programme of this nature into schools, you will actually lower drug use. One or two studies show the type of things that might happen and that some advantage might occur over a short period of time, but there is no really good peg on which to hang one's hat. I found two studies from the United States in the last two years which demonstrate clearly that if drug education policies are introduced into some schools, the incidence of drug taking is actually raised. That is really bad news, but it is not a fact that we can ignore.
The people who have been in the game longest are the Australians. They have been practising pretty thorough and complete drug education in their schools for just over 20 years. Last year two Australian states changed their policy. They are no longer going to try to teach kids not to use drugs; they are going to try to teach them how to use drugs safely because they have had to admit that the former policy simply does not work. Drug use is not only continuing to rise; it is rising at an increasing and accelerating rate.
The assumption behind drug education is that by educating children about the dangers of drugs, they will be able to make informed and responsible decisions about drug use, but will they and do they? That assumption behind drug education—we have talked about it in lots of different ways and have heard many different people talk about it in lots of different ways—is based on the idea that, currently, part of the problem is ignorance and that as soon as young people are educated and gain some knowledge, they will make better decisions. However, the Green Paper openly states that one of the problems facing teachers is that, on the whole, the kids know more about this than the teachers. So, if ignorance is not the problem, why would education be the answer?
Let us look at it from another angle for a moment. We all know the object of French lessons. It is to learn to speak and write French at a reasonable level. Like, I expect, most of your Lordships, I sat through about four French lessons a week for about 10 years and I have to tell your Lordships, with deep shame and regret, that I write and speak French appallingly. That was what happened when I was taught something positive, but with drug education we are trying to teach young people something in the hope that they will not do it. There is a lack of logic in that. I know that it was a silly example, but I think that the point is relatively clear.
There is another major difference. While my school was desperately trying to teach me French, my parents, family and wider friends were not desperately saying to me, "Don't speak French". But in the case of drug education, while the teacher may be telling the kids for one, two or three hours a week, "Let's not do this", the 724 wider community outside—their family, friends and the communities in which they are growing up—are insidiously and generally saying to them, "Do this. It is good. It's okay and it works". Who will win that battle? The reality is that it will be the wider community. It will be the insidious world in which we live, which is trying to persuade kids to take drugs, that will win.
There is a logistics problem also. The Department for Education in its statement and in the speech which my right honourable friend Mrs. Shephard made in launching the policy has announced that it will fund 10 innovative projects in the field of drug education. I do not know what your Lordships think, but I tend to believe that people who ask to be told about "10 innovative projects" only do so because they do not have any projects that work. They are looking for ideas. That is fine. If you do not have an idea, you look for one. So, we find 10 innovative projects, fund them, implement them and monitor them to see how they work, but how much time will pass? Another 10 or even 15 years will pass before we have the type of results that we need on which to base our judgments. During that time, drug use will rise. During the past 10 or 20 years, it has risen by about 1,000 per cent. So, while we are desperately looking for educational answers, on the other side of the coin the street will be beating us to it. I suspect that that is not an easy way of going about things.
We are already doing more work in the areas of education and prevention than ever before. The Home Office drug prevention initiative is now in its fourth year. As the Prime Minister said in his foreword, since 1990 it has started 1,000 projects, yet in those four years drug use has doubled. Does that show that those projects are successful? Well, it might be early days yet, but I do not think that it shows that they are successful because we must ask whether the object of the Home Office drug prevention initiative is to start projects or to lower drug use. It appears to be very good at starting projects, but it does not seem to lower drug use.
I ask myself, therefore, whether we are sensible to set as the cornerstone of the new policy a strategy that cannot demonstrate any tangible evidence of success. Are we really to place so much reliance on a strategy that at the end of the day may not work? That is not to say that we should not try such an approach. Of course we should try it. We should try everything, any innovative ideas. We should try them and fund them, but we cannot rely on them if we do not think they are going to work.
There is one thing we can look at that we have so far missed out. It does work. It is something that is not much mentioned in the Green Paper, although that is not entirely the fault of the Green Paper. I refer to treatment of the existing addict population. It is a difficult matter for the Government in relation to the Green Paper and I do not criticise them for their lack of attention to it when, as your Lordships know, they have taken some steps forward. They have certainly listened to what some of the people involved have been saying for the past few years. We have in place at the moment an effectiveness review. We have the Department of Health task force, which is investigating what forms of drug 725 treatment actually work, how much they cost and where they fit in with other measures. This will be a thorough review of the effectiveness of what we have at the moment. It would be silly to propose changes until we have the results.
Another point made forcibly to the Government over the last few years concerns the "bridge" between the voluntary and independent sectors; that is, the major area of drug treatment in Britain. The bridge organisation, the Standing Conference on Drug Abuse, was not working effectively. We felt that it was not as it should have been. The Government recognised that, and I congratulate my honourable friend Mr. Bowis on the work he has done. The standing conference has been completely reformed. There has been long and careful study by management consultants. A new executive director has been appointed and a new constitution formed. So it is going to be made to work. We see from the Green Paper that its probable role, which cannot be decided yet, is being outlined. These are major advancements; we must congratulate the Government on them.
Harking back to some of the comments made by the noble Baroness, Lady Jay, and by my noble friend in intervening, we heard about the two sides of methadone and abstinence. There are conflicts here. But these are not conflicts which need to be resolved on the Floor of your Lordships' House. These are clinical issues which should be resolved by their effectiveness. I suspect they will not be resolved to everyone's content. There has been much too much reliance clinically in this country upon maintenance programmes. We need to look at that aspect very carefully; indeed, we are doing so at the moment. The other side of the coin is that there is and always will be a very important role for methadone maintenance. We have not got the balance right but the way the Department of Health task force is looking at it and the results that follow will help us to correct the balance. So it is no small thing that the Government have done. I am confident that the results will be very beneficial.
I would have liked the Government to say in the Green Paper that, based on what the task force says, they will make a commitment to bolster treatment and fulfil the recommendations made by a combination of more resources and more effort. I hope that my noble friend, who is to reply, will confirm that it is the Government's intention to act on the report as best they can. It is, I recognise, difficult for the Government to go into details until the report appears.
Although there are many aspects of the problem that cannot be proved because we do not have all the evidence we would like, it is clear that the right sort of treatment applied in the right way at the right time works. The patient who is undergoing the treatment, the families and everyone involved derive substantial benefits. If something works, let us concentrate on that.
A fascinating study, the California drug and alcohol treatment assessment of 1992, is probably the most comprehensive report ever made on treatment in the western world: it must be of interest to anyone taking part in this debate. The study involved 150,000 people who had gone through treatment in California. That is 726 probably the entire number of hard drug users in this country. The cost was 209 million dollars but the saving to the Californian taxpayer was 1.5 billion dollars.
The report—it really is a tremendous report—revealed that the benefits of treatment outweigh the costs by a ratio of between 4:1 and 12:1. That is very concrete: it is something to go on amid the fog of misinformation in which we operate at the moment. If there is one single answer to the drug problem—I concede that there are probably many —it lies in reducing the existing addict population.
As I said, the Green Paper makes clear that there will be a major switch from supply to demand reduction services, largely because attempts to reduce supply do not work. However, the Green Paper fudges one of the most important issues. It would be wrong if I were to sit down, although I am sure your Lordships are longing for me to do so, without mentioning the issue of legalisation.
In what is generally a very serious and good paper, one element appears to me to be rather facetious and light. I wonder if that is not deliberate, so that we can have a debate about it in the future. The issue is dealt with in Annex D at page 111: it is probably the most important issue in the drugs world today. It is perhaps unfortunate that it is placed right at the back of the report. Some of the comments are important and need answering. The Government say:The case for change lies with those who are seeking to relax the law".It is important to realise that the case for change does not lie with those who seek to relax the law. The case for change lies with those who admit that the present law does not work and that we need to do something to make sure that it does work. In the Government's view, putting the argument around the issue of criminality is narrowing it. The most extraordinary comment appears in paragraph D.3:Of course, taking certain laws off the statute book brings about a technical reduction in crime figures. Yet no one would suggest decriminalising armed robbery or assault on that basis".What an extraordinary thing to say! No one has suggested that for a moment. I have never heard such a suggestion made. It is completely ridiculous. The issue is not the possession of cannabis or other drugs; the issue is around wholesale and massive acquisitive crime, and the motive behind that is to steal drugs put out of people's reach by a black market created by government. That is not an opinion but a fact. Whether we choose to do something or not about it is open for debate.
The blanket withdrawal of legal controls over drugs would be unwelcome, from a health point of view, it is said. Yes, of course. Whoever suggested otherwise? In the entire debate on the issue surrounding the legalisation of drugs, I have never heard anyone suggest the blanket withdrawal of legal controls. Indeed, most of the debate centres around making the legal controls work. The Government go on to say:while acquisitive crime … might be reduced by free available low-price drugs".727 That is the nub of the issue. If you destroy a black market, take it over and lower the price, people are not going to steal to raise the money. That is the key to the issue.
The second, and most important, question at the end of the day, which the Government fasten upon, is this: would the benefit, in terms of reduced crime, be heavily outweighed by the human cost of widely increased drug dependence? There is only one purpose in legalising drugs. It is not to beat the drug issue, because it does not beat it. It is to tackle the issue of crime. It is very likely that if Government were to control the drug market, as it controls the pharmaceutical market, the tobacco market, the firearms market, the motorcar market and in fact every market we can imagine, they could control the price and hold it down at its real, as opposed to its black market, level and thus vastly reduce crime. If we can control and destroy the black market—there is every reason to believe that we can, because it has been done before—we would inevitably make drugs more available. There is no escaping that fact. If they are more available, how many more people will take them? That is the price we have to pay. That is the question we have to answer. We do not know, but we can make some reasonable assumptions.
If Black Rod were to come charging into your Lordships' House and say, "By the way everybody, heroin is legal", how many of your Lordships would rush out and buy some? Probably not many. One or two might—those with gout—but probably no one else. The reality is that most people over the age of 30 who are not currently using drugs will not rush out and start; most people under the age of 10 who have not yet started using drugs will not suddenly start. The danger area is for those aged 10 to 30. They are the ones identified in the Green Paper as currently taking drugs in ever-increasing numbers. We need to direct our services towards them. We are directing our services towards them at the moment, but we cannot direct the services that we would like because so much money is tied up in the criminalising and policing of drugs. That is the area at which we need to look closely.
My right honourable friend the Home Secretary, addressing the question in the summer, was not convinced of the link between drugs and crime. That may have been because he probably had not read in detail the Greater Manchester Police model research on drugs which had come out earlier. I know that he had read a little of it, because he had a copy in his hand. However, he obviously had not read it in detail. It is the most extraordinary piece of research. It demonstrates the undeniable link between drugs and crime.
I shall not go into the research now because I have been speaking for far too long. It is an extraordinarily strong piece of research. It is not good enough for a Home Secretary, or anyone else, to stand up and say that he is not convinced. Why is he not? Which figure is wrong? Let us look at it now. I have spent a great deal of time looking at it. I have asked and talked about it in detail. It is a convincing piece of research, but we do not base government policy on just one piece of research. The answer is simple. Let us do some more.
728 Let us do it in London; let us do it in Halifax; let us do it in Timbuctoo; let us do it anywhere we like; let us see—is it a freak research, or is it real? If it is real, and if it is repeated, we need to take it seriously. It demonstrates that the 1,500 registered drug addicts in Manchester cost Manchester taxpayers £26 million in any one year.
That figure contrasts unfavourably with the Government spending £25 million on health care. We cannot afford to be spending those millions throughout the country. That figure relates to 1,500 addicts. The true number of registered addicts throughout the country is 15,000. If we accept the estimates, the number goes up to 150,000. Your Lordships can do the mathematics yourselves. It is the biggest area of crime. If there is the smallest possibility that we can reduce the incidence of crime considerably or even wipe it out we cannot dismiss the matter as it is dismissed on page 111. It needs to be looked at carefully.
I started—I have come full circle—by saying that this document is important. It is. It contains much of which the Government should be proud, but it is a start only. If I were a schoolteacher, I should be tempted to say, "A very good first effort, but rather lacking in content". Fortunately, I am not a schoolteacher, but I am reminded of one of Sherlock Holmes's frequent and rather cruel admonitions of Dr. Watson, when he said to him, "Watson, you must make sure that the theory fits the facts. You must not select the facts to fit your pre-chosen theory".
I have a feeling that in some areas of the Green Paper, we have a pre-chosen theory. The only way in which we will come up with the right results is if we use to the full the facts that we have, and where we do not have them that we do the research necessary to obtain them. Then, when we have the facts, and admit their full extent, we shall have a theory. I therefore look forward to the publication of the Government's White Paper.
§ 4.54 p.m.
§ Baroness Masham of Ilton
My Lords, because of the concern at the increase of drug abuse, I put down an Unstarred Question for Wednesday 19th October which asked the Government what they were doing about it. As several noble Lords wished to speak, I must apologise if any confusion was caused. The debate was delayed because the Government wanted to make a Statement. They then brought out their important Green Paper Tackling Drugs Together. What was an Unstarred Question on the subject has now grown into a major government debate with two Ministers speaking. I should like to say how grateful are the organisations involved for the interest shown and the encouragement given by the Minister, the noble Baroness, Lady Cumberlege, who attends many meetings with them, especially on AIDS.
Up and down the country encouragement is being given to HIV and AIDS awareness, and 1st December has become known as World AIDS Day. Drug abuse and AIDS are world problems. It is with great sadness that I remember today several people who died too 729 young because of those two enormous disasters which cause so much heartbreak and anguish to families and friends across the world.
Drugs penetrate into homes, universities, schools, pubs, clubs, prisons, sports organisations, airports, railway stations and many other places. Drugs have penetrated all kinds of communities within inner cities, market towns and rural areas. The purchasing, providing and marketing is done as skilfully as in any successful business. The result to society, without doubt—I am sure that the Minister will agree with me when she sums up—is that the trade in illegal drugs has increased the amount of serious crime committed. We knew that crack would be a real danger. Our worst fears have been realised. The spread of crack has increased the amount of violence used and the carrying of guns. I ask the Minister, the noble Baroness, Lady Blatch, what suggestions the Government have for tackling seriously the problem of crack.
As many noble Lords will know, crack comes in small rocks of pure cocaine. It is smoked rather than snorted. As the drug travels directly from the lungs to the brain, its effect is more powerful. As a result of its immediate impact on the brain, all its effects are magnified. The "rush" is intense. The individual enjoys less than 15 minutes of intense rapture, exultation, confidence and feelings of well being. However, the intensity of the "rush" appears to speed up the rate of dependency. Once dependent, the user uses the drug not to feel good but to avoid the crash—the inevitable depression.
The implication for an addict's health are enormous. Most seriously affected are the respiratory system in respect of which it causes chronic bronchitis and the cardiovascular system in respect of which it causes irregular heart contractions, increases blood pressure and results ultimately in heart attacks. Other complications include depression, anxiety, epilepsy or seizures. Further problems are caused to pregnant users.
With so many law and order implications associated with the drug trade, I was surprised yesterday to read that many jobs in the Customs and Excise are being cut. I should like to congratulate the staff of Customs and Excise on their recent big drug hauls. I am sure that the Government's answer will be that most of the work is done by undercover work. However, it seems that a combination of many people working together—for instance, undercover police and customs officers—with the public and government departments giving support, is the answer. Detection and success in finding the drugs is such a difficult and skilled job. With so much deregulation, will this not make Britain more vulnerable to the drugs trade?
This year I visited two prisons where drug initiatives in rehabilitation are going on. I am sure that the treatment and rehabilitation of prisoners addicted to drugs is worthwhile. We all know that, as with alcoholics, it does not always work. One prisoner told me that he had re-offended within 24 hours of leaving prison and had planned his first job before going out.
Drug dealing within prison is very dangerous. Prisoners can get into debt and the drug barons will have systems of threatening the families outside if they do 730 not pay. If needles are circulating in a prison the prisoners will be at risk from HIV. The prisoners will have mood swings and paranoia, and can be violent. I have always believed that as regards any form of health education prisoners are a captive audience and it is time well spent. If they learn something useful it may help their families and friends when they are released. We have heard that urine testing will take place in prisons. I very much hope that along with it will be treatment. Without treatment there can be violence, as has been seen in some prisons, and riots should be avoided at all costs.
I see hope, and I hope that the Minister will tell the House that treatment and rehabilitation will be increased throughout the prison service. As Turning Point stated:There is no quick fix to drug policy. The misuse of drugs is the outcome of a whole range of social factors. There is no one approach that will work to prevent or cure every individual; only harm comes from claims that one treatment is the only correct one".Surely, the wise procedure should be to find a policy that will determine an effective balance between the control of drugs and prevention and treatment. Every community needs to understand the particular nature of the drug problem in its area and to create a range of services to deal with that.
Phoenix House is an organisation which deals with several rehabilitation houses for drug abuse throughout the country. I chaired the organisation for several years and saw the important work that it did with serious drug users. As well as catering for individuals in the community, it works as an alternative to prison. In recent years it has set up some family units so that children are not separated from their parents. The National Health Service and Community Care Act has meant that it can now offer only shorter programmes to clients because of local authorities' unwillingness or inability to pay for anything else.
I would like to give your Lordships an example of the administration difficulties encountered by homes such as Phoenix House. Phoenix House has to contract with approximately 80 per cent. of the local authorities in England. All this is done on the basis of individual contracts for each service user. Each service user's contract may involve contributions from up to three or four different parties; for instance, health money, probation money and social services money from different sections within the department. The main impact that this has had upon them has been to make critical the issue of cash flow in view of the fact that over 55 per cent. of their income is now dependent on this source. They are extremely concerned that a number of local authorities are saying that their community care money has run out. At least two of the local authorities which have publicly announced this are major referers to Phoenix House services and there has been no public or media discussion about the impact of this on drug and alcohol service providers. They have ample evidence to suggest that decisions to fund people are as finance-led as they are needs-led and that there is great pressure on officers within social service departments to keep the purchasing of residential care for their client group as low as possible.
731 Some local authorities continue to be slapdash in their approach to care management, and Phoenix House experiences difficulty in getting them to take a full part in the review of a client's progress. In one instance, funding was withdrawn from somebody despite repeated requests from Phoenix House to the local authority concerned to attend care reviews. There was no response to our requests and no involvement by the relevant social services department. Then an arbitrary decision was taken to withdraw funding. The client concerned consulted solicitors and the subject is a matter of judicial review at the moment. In the meantime, an injunction has been granted to the client whereby the local authority is to continue funding and has been instructed to carry out an assessment. This is not an isolated incident. If one does not have rehabilitation services there will be more chaotic people using drugs in the community.
On a positive side, some local authorities are beginning to approach funding clients very creatively. There are now instances of local authorities having funded nursery nurses at the Phoenix House Hove Family Project and aftercare for people in private-sector tenancies in order that those from Phoenix House can continue to visit and support them following their departure from the house. Both of these were previously unfundable and other initiatives are to be welcomed.
Phoenix House, with all its experience, will be very pleased to help in any way that it can with the Central Drugs Co-ordination Unit and the task force, which is looking at the effectiveness of interventions with drug users. It is vital that, if the phrase "tackling drugs together" is not just words, everybody concerned works together and that statutory bodies put aside any professional jealousies when dealing with non-governmental organisations.
Everyone in Government should be working closely with voluntary bodies as many of the people working at ground level are closest to the problems. Some have been there themselves and know the weaknesses and the ways around. They are streetwise. I should like to recommend Fountain House. It is a nursing home for people who have been or are drug users or have HIV or AIDS. The facilities are excellent. I wish only that there were such places for other groups of disabled people.
Fountain House is run by Phoenix House. Having attended its opening in the summer, when my noble kinsman was in a BUPA hospital, I found that the bathroom facilities were much superior to those provided by BUPA. It also has a friendly approach and a lovely garden. Much thought has gone into making it patient-friendly.
I hope that what people will have read in the papers and heard on the radio and television today will stop them being complacent about HIV. Prevention is so vital. The problems that exist in Africa now exist in Asia. I read the sad story of the missionary nurse who became infected through her work and is now dying of AIDS.
I would ask the Government to look at and help with the difficult problems for women who have HIV and who have AIDS. So often they are running a house and 732 family and do not have people to look after them. They are the carers. Transport to enable them to reach treatment can be difficult and to travel long distances with children when one feels ill is not so easy. The Mildmay Mission Hospital now has a family unit and the London Lighthouse is considering services for women, but is finding it difficult. I hope that the Government will listen to Positively Women who understand the many problems in this area. There needs to be a choice and there needs to be flexibility.
Education is vital. Such organisations as ACET, AIDS Care Education, are doing a great deal to help. It is very important to have responsible and effective sex education in schools and colleges. ACET distributed over half a million copies of the booklet HIV, Facts for Life. Education on HIV, AIDS and drug abuse and other health problems, and a positive approach to keeping healthy, need to be available not only to students but also to parents, teachers and governors who need educating. They all need training.
Recently a girl aged about 11 gave her biology teacher a packet of white powder and said to him, "I found this in mummy's bag: I want her to stop taking drugs".
Many people in Yorkshire were shocked when they read in the Yorkshire Post last Saturday about a young couple who were found dead in the lavatory of a restaurant in Dewsbury. They had died as a result of a drugs overdose. Their young son was in the restaurant play area oblivious of the tragedy. There will not be an easy way out of this terrible problem.
I should like to mention an important point. I have heard from the health authority on which I serve that there will be total funding for some GPs. When GP fund holding is extended, it will be very dangerous if this is extended to GUM services. Patients who may have a venereal disease or who think they may have HIV need confidentiality of the highest level. There are a few GPs who do exceptional work and who do care. They, of course, should be funded for the services they provide. However, many people do not want to go to their GP for various reasons. There should be freedom of choice, and prevention of drug abuse and HIV should be paramount. I hope that the Green Paper will stimulate debate across the country. All the people working in prevention, education and treatment need encouragement. As the noble Lord, Lord Addington, said, this is a long-term process.
§ 5.13 p.m.
§ Baroness Gardner of Parkes
My Lords, today is World AIDS Day and as so many speakers have pointed out, it is a very appropriate day for this debate. I welcome the Green Paper. I notice that the Motion asks us to note it, which I do. I do not intend to speak on the Green Paper but I think it is good that we have it.
As far as drug users are concerned, a point that has not been mentioned is that HIV is only transmitted if one person already has an HIV infection. Therefore, the most important matter is to control the spread of AIDS and HIV; and to do that, early detection is of course important. Simple tests can confirm the presence of HIV and these tests should be encouraged, not discouraged.
733 Any deterrent to people presenting themselves for tests must be removed. In the past, insurance application questions have been a problem. A national survey carried out in 1991 by the Department of Health estimated that the numbers being put off having HIV tests were,certainly in the thousands, possibly in the tens of thousands".The Secretary of State said at that time about testing:We must remove the barriers in the interests of public health".This has not been easy and the Terrence Higgins Trust has played a significant part in this matter, but I must give full credit to the Department of Health for its success in persuading the Association of British Insurers to change the questions on application forms. This change affects all those, heterosexual or homosexual, who are considering an HIV test. I am informed that in the past many GPs have not recorded the information that someone was seeking an HIV test for fear that it might prejudice an insurance application. Many patients still choose to use the anonymous testing centres. There is a clinic at the Royal Free. Patients may enter it in the morning, be given a number and can have the result in the afternoon. No names are asked.
On 25th July the Association of British Insurers announced in a news release the withdrawal of its previous recommended question on HIV/AIDS testing and the introduction of a new one. One of the reasons for this is that over the past two years, as the association said, testing has become much more commonplace for screening purposes. The question now only asks whether a person has had a positive test. The previous question had asked whether someone had had a negative test. On health grounds, I think it wrong that anyone should ask whether a patient has had any negative test of any type, whether it is a test for breast screening, or a chest X-ray or any other sort of test. Surely it must be good that a person should be screened for a condition rather than have that held against him when applying for insurance. I believe that it is right that the Association of British Insurers has decided that it is no longer appropriate or necessary to ask the previous question. It has produced a new recommended wording. The question now is:Have you tested positive for HIV/AIDS or Hepatitis B or C, or have you been tested/treated for other sexually transmitted diseases or are you awaiting the result of such a test"?Everyone is satisfied that that new wording protects the insurance companies. After all, they cannot give open insurance to someone who has had a positive test, no matter whether it was a positive test for cancer or HIV or any other condition. The insurance companies had a sound point in that regard when they said they would have had to increase all premiums considerably if no such questions could be asked. However, the new recommended wording was considered satisfactory and a code of practice was issued.
Some companies have already reprinted their forms, one of which is the Scottish Provident but it has still not really quite complied with the new wording. A sample form of the Scottish Provident asks:Have you tested positive for HIV/AIDS or hepatitis B or C?".734 That part is all right, but then the form puts an entirely separate question:Have you ever been tested or received treatment in connection with any sexually transmitted disease, or are you awaiting the result of such a test?".That, again, is asking someone to declare a negative test and I think that attention should be drawn to that.
In the copy of Which? dated 1st December 1994 there is a section on that, very point. The magazine asked 105 life insurance companies whether they had changed the wording on their forms to reflect the new code.
The article states that,67 replied, and almost half said they have changed the wording on forms … The rest said changes will be introduced from January 1995. [But] if you are sent an old form and object to the HIV/AIDS questions, contact the company and ask for the new style of question as agreed by the ABI".Although that advice is sound, I still think that it leaves people feeling a bit vulnerable if they have to phone and ask for a new form because people would ask them why they needed a new form and why they could not complete the old one.
If the code of practice has been changed, it should be complied with. For that reason there are a few questions that I must put to the Government. Do the Government know that so far only 50 per cent. of insurers have complied with the guidance? Is that acceptable? Does the Which? information that the remainder intend to comply by 1st January 1995 accord with the Government's information on this? Are the Government satisfied that that will happen? Were they aware that that one major company—Scottish Provident—had made that something of a trick question by dividing it into two, as I pointed out?
It is very important, as a public health issue, for us to realise that detection is an important aspect. Anything that discourages people from attending clinics is not in the interests of the public. If people are diagnosed as having HIV they will perhaps act differently towards others. However, if they are not aware of having HIV they do not give any thought to what might happen to others.
Therefore, although work is continuing worldwide to find a cure, and there is no cure for AIDS at present, I believe that the time will come when we come closer to a cure. Perhaps we shall first reach a stage where the disease is controllable. It will then be in the interests of patients for it to be known at an early stage that they have the disease. In most diseases the condition is more easily treated at an early stage.
Those are specific questions, but they are relevant to our debate on this matter of HIV and AIDS. Although drugs are one means by which the disease is transmitted this is, as many speakers have said, a much wider issue, and therefore I feel that I have to put those questions.
§ 5.21 p.m.
§ Lord Rea
My Lords, I should make it clear that in this debate I am speaking from a Back Bench—although not very far back because the Benches at the very back of the Chamber are very cold. What I shall say is not yet Labour Party policy, although naturally I hope that in due course that will move in my direction.
735 The Green Paper will be useful if it stimulates debate on a countrywide basis and the White Paper which follows it takes account of some of the questions—and provides some answers—which will arise as a result of that debate.
Internationally, the drugs trade is estimated to handle goods worth some 254 billion dollars to the major traffickers. That is equivalent to approximately a third of our national income and is the same as the United States defence budget. No wonder Colombian or mafioso drug barons can defy, suborn and sometimes outgun governments. I am afraid that the Green Paper gives no sign of any new policies which are likely to make any noticeable impact on the operations of those very rich international gangsters. Making 550 Customs and Excise officials redundant does not seem likely to help to achieve the Government's aims. That makes me wonder whether the Government are wholeheartedly behind the aims set out in the Green Paper.
As a general practitioner who has had a number of drug-dependent patients over the years, I should like to concentrate on the health problems created by drugs. It is important to recognise that these are in two categories: those which can be ascribed to the active principle of the drugs themselves, administered in a normal dose or, if injected, using a sterile syringe needle; and those which occur as a result of obtaining drugs illegally, in an impure state, in a cloak-and-dagger market "on the street". I say to the noble Baroness, Lady Masham, that I would place crack cocaine in that category.
It is that latter category which results in the heavy burden on the NHS—mentioned in the Green Paper—on GPs in their surgeries and accident and emergency departments throughout the country. Those problems can be due to an often fatal overdose as a result of a batch of a drug being less "cut" or adulterated and thus stronger than expected. They can be due to an abscess and septicaemia as a result of the use of shared or otherwise unsterile syringes or needles. As many noble Lords have pointed out, HIV and hepatitis B are spread by the use of shared injecting equipment.
A pure drug can have long-term effects, as indicated in the Green Paper, in the same way as nicotine—which is the most addictive of all drugs—and alcohol. However, few, if any, of the currently controlled drugs—whether opiates, including heroin, cocaine, cannabis, or other soft drugs—have worse long-term effects than nicotine, which is lethal even when used as indicated, or alcohol with its adverse social effects, liver damage and carcinogenic effects when used in excess. However, in favour of alcohol is the fact that in low doses—fewer than 21 units for men and 14 a week for women—it has been shown to be beneficial to the cardiovascular system.
Whatever may be the long-term clinical, psychological or social effects of the use of unadulterated controlled drugs, they are not the problems which concern GPs and accident and emergency departments, where the ill-effects seen are mostly due to the impurities and varied strengths of street drugs and unsterile injections.
736 There is a tendency by many to regard those who use drugs as beyond the pale or morally tainted. They are stigmatised. However, that has no logical basis, any more than it would be logical to regard smokers or drinkers in that way. The Green Paper gives some statistics to show how widespread the use of illegal drugs is now in England: 44 per cent. of 20 to 24 year-olds in inner cities use drugs; 14 per cent. of those aged between 12 and 59 have experience of cannabis use. In a survey of a true random sample of patients registered in a group practice in North West London earlier this year funded by the North Thames Regional Hospital Authority, I found that 48 per cent. of females and 51 per cent. of males aged between 16 and 44 had used cannabis at some time, and 18 per cent. were current users.
Most controlled drugs, as with nicotine and alcohol, can give pleasure, and produce relaxation or increased feelings of awareness or alertness. If used occasionally, or even regularly, in a reasonable dose as a pure substance, they cause minimal or no harm. The same could be said of alcohol. Similarly, habitual or excessive use may cause harm to some people, although others seem to get away with it. The violence associated with drug use is not due to the drug itself but almost always to disputes among rival traffickers in illegal drugs. The effect of drugs is only on the person concerned, much more so than with alcohol, which has serious social effects.
It may justifiably be said that there is often social pressure, as well as pressure from pushers, on young people to start using drugs. That has been mentioned by a number of speakers. I agree with the Green Paper that, theoretically at least, health education about drugs can be useful. However, the noble Baroness must pay heed to the remarks of the noble Lord, Lord Mancroft, and take note of the Australian experience. The same applies to tobacco and alcohol, and also to sex education. We need to prepare people to handle their actions in a healthy way. We must take note of what is happening and not preach to people to stop. Of course the harmful effects can be mentioned in health education, but it is also very important for young people to be shown how to behave and how to use substances in a safe and healthy way. With regard to tobacco and alcohol, the pushers are the manufacturers themselves who promote their products through widespread and highly effective legal advertising.
Deaths and serious health problems from illicit use of controlled drugs almost always occur among heavy habitual users, although accidents happen with novices who may not yet have developed tolerance. It is for those chronic users that treatment and rehabilitation facilities need to be available in every health district, with more in those with a high prevalence. We should take note of the difficulties that the voluntary sector is having in keeping some of those centres going. Those centres should be able to assist users who genuinely want to come off drugs, as well as those who are "stuck" and cannot manage to face a drug free life, even though logically they would like to. My long experience with drug users has convinced me and many other realists 737 that many users will not succeed with drug reduction programmes until they are ready—and that may be many years ahead.
The Green Paper mentions that methadone programmes—the noble Baroness also referred to them—in several centres will be evaluated. That is very good so far as it goes. But I have found that many long-term addicts are quite reluctant to use methadone as a heroin substitute. It is well known that many, perhaps a majority, of heroin users who have a regular supply of methadone sell it on, in order to help to buy the heroin that they really want. A recent Home Office statistics bulletin indicates that more deaths are now notified as due to methadone than to heroin although there are fewer methadone users.
There is a strong case for treatment centres to be allowed to prescribe heroin to certain long-term users, not necessarily to be injected but, for example, made up as reefers which give a "high" rather like an intravenous injection but without the danger.
Between 1920 and the mid-1960s confirmed drug addicts were prescribed the opiate they needed and the problem remained very small indeed. Since that policy—following the recommendation of the Rolleston Committee—was abandoned, the problem has vastly increased. The decision to offer only, or mainly, reduction programmes in drug clinics has been totally ineffective in reducing drug dependency, as the noble Lord, Lord Mancroft, pointed out.
It would be too simplistic to say that that more restricted approach has been the only reason for the rise in drug abuse. Of course, the easy availability of air travel would have increased the number of addicts in Britain, or elsewhere in the world, in any case. But the approach up to now of restricting prescribed drugs has had the effect of greatly encouraging the illegal black market as well as increasing the health hazards of drug use including the spread of AIDS. What success we have had in slowing HIV transmission in drug abusers—it is considerable, as my noble friend described—comes from the recognition that many users will not be able to give up the habit, at least in the near future. However, the very best success rates in preventing HIV transmission are achieved in clinics in which maintenance drugs are prescribed. I cite as an example the Widnes Clinic which routinely tests its clients for HIV and has yet to detect a new HIV case.
Perhaps I may say a few words about drug related acquisitive crime. The Green Paper calculates that heroin abuse generates a maximum of £864 million worth of stolen goods, on the basis that a thief obtains one-third of the value of the stolen goods. In my opinion, and in that of the addicts I have questioned, the proportion is more likely to be one-fifth, or even less. That means that such thieves will need to steal nearly £1.5 billion worth of goods to raise the estimated £288 million that they need. That calculation relates to heroin alone. The total value of goods stolen to buy drugs is probably nearer to £2 billion; that is, nearer to half of all acquisitive crime than the one-fifth estimated in the Green Paper.
738 Supplying long-term users with the substance that they want on a daily basis, strictly controlled, until they are ready to come off in their own time would have a remarkable effect on crime. At that same Widnes Clinic with the good HIV record, a study was done by the police on the crime records of 142 clients before and after starting maintenance treatment. The convictions dropped from 6.88 to 0.44 per person during comparable periods of one-and-a-half years before and after the treatment. That is a reduction of 15 fold. It is no wonder that senior policemen in all parts of the country are in favour of a change in the current drug policy—disappointingly a change which is not suggested by the Green Paper.
Noble Lords will no doubt be thinking that what I have suggested might lead me to the conclusion that legalisation of drugs would be a logical step. If so, they would be half right and half wrong. The noble Lord, Lord Mancroft, has referred to the annex of the Green Paper entitled "The legalisation debate". It sets up some Aunt Sallys and proceeds to knock them down. I cannot help quoting again the passage to which he referred which states:Of course, taking certain laws off the statute books bring about a technical reduction in crime figures. Yet no one would suggest decriminalising armed robbery or assault on that basis".That fatuous comparison completely misses the point. Drug use in itself harms no one except perhaps the user if he or she uses it foolishly. If drug use were decriminalised, a user would still be committing a crime if they indulged in robbery or assault or were being a public nuisance; and other legislation exists to deal with that.
Perhaps I may refer again to the same passage as the noble Lord. It is true that,the blanket withdrawal of legal controls … would be unwelcome".That would certainly result in an increase in drug use, although whether to the same extent as use of tobacco or alcohol is doubtful. At the moment, society suffers a blanket lack of controls on tobacco and alcohol. I believe that there is plenty of room to increase such controls, as noble Lords who listened to the debate last July on banning tobacco advertising will have realised.
I believe that there is a strong case for decriminalising cannabis, but not as yet for opiates, cocaine and some other drugs, although that must be a possible future option. Three countries in Europe—Denmark; Holland and Germany—have relaxed restrictions on cannabis by looking the other way, by letting the market operate. I suggest that we do it by licensing certain outlets—for example, pharmacists—to supply cannabis under a state monopoly. In that way quality can be controlled, a record kept of the amount sold, and excise duty charged for the Government's and taxpayers' benefit. Canada and Scandinavia have a similar system for alcohol which seems to work quite well. The price must be low enough and the availability widespread enough to make a black market uneconomic, but high enough to make the buyer think twice. Cigarettes and alcohol set a precedent.
In 1991, 84 per cent. of all drug offences were concerned with cannabis. If that drug were decriminalised the police would be freed for more urgent tasks. The decriminalisation of opiates and 739 cocaine cannot be done in one country alone. International agreements will be necessary among a group of nations before that is possible. The Dutch experiment indicates that one nation cannot do it alone.
However, short of legalisation, the demand for heroin and other opiates would be greatly reduced if more treatment centres were able to prescribe on a long-term basis for confirmed users. Not only would their health benefit, but they would not need to trade in heroin, as they now do to help finance their habit. That would have a major effect on reducing the amount of street heroin available to attract younger non-users, some of whom, having experimented with it, become dependent upon it.
In conclusion, I am sure that the world will eventually realise that prohibition of addictive substances is a recipe for disaster, as did the United States Congress in the 1930s after the disastrous period of alcohol prohibition in the 1920s, which resulted in an increase rather than a decrease of alcohol use and a wave of organised crime and gang warfare. That is where we are now, worldwide, in relation to drugs. Until that basic truth is accepted we shall continue to knock our heads against a brick wall and the problem will get worse. I am afraid that the Green Paper brings us no nearer to a real solution.
§ 5.41 p.m.
§ Lord Gisborough
My Lords, first I must apologise that I have to leave before 6 p.m. so I shall not be able to stay for the end of the debate.
I think that we can all agree that the control of the import of drugs is not getting any better and for every shipment that is intercepted there are many more that get through. The new open frontiers of Europe, along with the increasing ingenuity of the so-called drug barons, make the problem of interception ever more difficult. In spite of some successful drug interceptions, the enforcement agencies throughout the world are fighting a losing battle against the force of the drug barons and the weight of their finance. We are told that they could lose 50 per cent. of their shipments and still make a large profit, possibly an even greater one, as shortage of supply increases the price and the profit. Moreover, the drug cartels now control such huge investments that this alone poses a dangerous and serious threat to the economies of many countries—probably far greater than is appreciated, if one is to believe what one reads. It is said that every dollar bill in the United States now has a trace of heroin on it.
Articles have appeared suggesting that the scale of the drug economy is colossal, even in the terms of national budgets. If those reports are really true then it is a serious danger. The stranglehold in many countries of this new Mafia over police, politicians and judges by violence and economic muscle is fast becoming as big a danger as the drugs are to the addicts. Traffickers have the muscle to bribe and threaten on an ever-increasing scale which could lead to situations such as the Mafia in Sicily.
One small example in Glasgow was of a policeman investigating a drug case. His dog was shot and he was warned that his wife would be next. Physical threats and 740 huge bribes are in danger of interrupting the whole battle against drugs. As the noble Lord, Lord Rea, mentioned, there is a similarity with the days of prohibition in the United States where scarcity of alcohol drove up the price and made a fortune for bootleggers. It is the same now with drugs: the more the prohibition, the greater the incentive to trade in them at a vast profit. Even where the penalty is death, as in the Far East, people will still take the risk of the high profit available to them.
If we are to stop the trade in drugs and cannot do so at our frontiers, we must look for other means of stopping it. There is another way that would be far more effective and far cheaper and it is different from the legalisation set out in Appendix D of the consultation document. As has been described by the noble Lords, Lord Mancroft and Lord Rea, it is by the route of making heroin freely available to any addict on prescription on the National Health Service through specific clinics, though definitely not, of course, to first-time users. Once that was the case, heroin would no longer have any value on the streets, as it could be got for the asking. The profit motive would be destroyed, it would be unnecessary for a pusher to burgle or to push drugs to get his own fix as he could just go to the clinic and get his ration for free. He would be allowed enough for that day only, so he would have little over to sell, but above all else, he would have no incentive to do so. There would be no point in the drug barons taking the risk of sending the heroin into the country, as no one would want to pay for what they could get for free. Free availability on prescription definitely does not mean that it would become legal to trade heroin, any more than it is legal—other than for a chemist—to trade pharmaceutical drugs. That would send out very much the wrong message.
I believe that Holland and Spain have legalised drugs and it has proved to be a disaster. Legalisation is not the road to take, but as the noble Lord, Lord Rea, explained, free availability is another matter, although there is a fine difference. Indeed, the penalties for dealing should become far more severe, to equate with the death sentence of the Far East, with a very high minimum prison sentence to force the users into the clinics where it could be had for free. That would provide a very large carrot and a very hard stick. The only potential buyers would be non-addicts wanting it for the first time—a minuscule market compared with the supply to regular addicts.
With the bottom having dropped out of the market, the illegal supply would dry up, making it harder for new people to become addicts, while the established ones would be no worse off, but would have become identifiable for treatment and advice. Meanwhile, the National Health Service could buy its supplies cheaply from such third world countries of its choice where it could be grown legally and under some degree of control.
The cost to the National Health Service of freely available drugs would be a tiny fraction of the cost of the drugs available on the black market, and would be offset by the great savings in the cost of treating HIV, and the huge and dramatic reduction in drug related 741 crime. At the clinics, addicts would be well treated as customers, but would be identifiable, and could be subjected to information, education and encouragement to come off the drugs.
It is true that the state would be providing the wherewithal for the addict to commit suicide. But the fate of the addict, who is harming himself by his own will, and who would anyhow get his fix by foul means if not by fair, must be set against the failure of present control methods, the misery of those contracting HIV, the interference with justice by the drug Mafia, the hijacking of capital assets, and possibly financial institutions, and above all the misery of the victims of drug-related crimes, who have done nothing to deserve the distress of being mugged or robbed.
I am glad to see in the consultation document that more attention is to be given to drug information in schools. I wonder why that has not happened before; it must be the key. But if, despite the warnings and information that he receives, the addict insists on abusing himself—and he will do this whether he gets the drugs free or by burglary —it is better that he suffers his self-inflicted injury without hurting the rest of society.
I am told that it is difficult to persuade an addict to make a change until he has reached the gutter of despair. Making the drug freely available would put him in that position much sooner, but he would then have immediate access to rehabilitation at his clinic as soon as he was ready to accept it.
There is then the whole question of all the other drugs that are taken. Perhaps if heroin were to be readily available free, the purchase of other drugs would become less attractive. Few people will pay for what they can get free. But taking heroin off the streets would be an advance even if it did not solve the rest of the drug problem.
Many traffickers are known to the police, but cannot be picked up due to the restraints on the way in which the police can obtain evidence. The new law relating to the loss of the right to silence will help, and there are other advances that will help to address this problem. One of the most important things is that there should be ever-increasing co-operation between agencies, not only to include people such as the Customs and action groups, but also foreign agencies. However, things are moving in the right direction and improving. We heard from the Minister about the plans that are afoot and they are encouraging. Furthermore, there seems to be reasonable satisfaction with the police and with the way in which drug dealers are sentenced in court.
Free drugs is a very easy policy to misrepresent. When the Labour Party in Malta tried to introduce it, it contributed to its downfall. It is too easy to misrepresent the policy as "being soft on drugs". However, before we dismiss such a scheme, let us ask ourselves whether the present method of control, namely interception, is or has any chance ever of working. If the answer is no—and I believe that to be the case—then it is time to be very brave and to face the alternative.
Free drugs without legislation to trade them should be given serious consideration. But, whether or not the concept of free heroin is accepted, Tackling Drugs 742 Together is a very good start and should eventually lead to a national drugs strategy which it is to be hoped may have some effect.
§ Lord Gisborough
My Lords, I would not want to argue about that. The point is, if the drug is made sufficiently available to the drug users that would kill the trade and make it totally unprofitable for the drug barons to import it.
§ 5.51 p.m.
§ Lord McNair
My Lords, I am pleased that the Government have given us a chance to debate two very important subjects. But I do rather feel that today we are debating two separate issues. AIDS and HIV are part of the drugs problem, and the spread of AIDS and HIV among drug addicts is only one of many health problems which drug addicts face.
I can find much to agree with in the Green Paper. I was particularly heartened by the descriptions of some of the local initiatives and the success that they are having in rebuilding the confidence and sense of security of some communities which are threatened by the drug culture. I wonder whether those projects involved a lot of money being put into a small area, or whether the sort of cost for the projects could be borne by the local authority, which may have several such areas within its boundaries. I am also pleased to see that the slightly secretive Cabinet sub-committee of three years ago has blossomed into full-blown interdepartmental collaboration, which is very welcome. In particular, I welcome the intention to put more money into drug education—although, bearing in mind the comments of the noble Lord, Lord Mancroft, to whom I always listen with great respect on the matter of drugs. We should put more money into drug education; but it is important to evaluate different kinds of drug education and to see what works and what does not work.
I should like to make a point about the health of those suffering from HIV and AIDS. Over the past couple of years I have become very interested in the possible benefits of treating these conditions by means of the oxygen therapies. This is a fairly technical matter but it is timely that it should be aired in this House. The oxygen therapies are the various ways of using oxygen as a bactericide and viricide. They comprise treatment with hydrogen peroxide, orally or intravenously, and treatment with ozone by infusion into the blood either intravenously or by removing a small quantity of blood, passing the ozone through it and then returning it to the body. I have met twice with the noble Baroness the Minister, once in 1993 and once last summer, to attempt to persuade the Government to provide funds for a 743 proper investigation into the efficacy of treating AIDS and HIV with hydrogen peroxide. It would be appropriate also for them to investigate the various forms of ozone.
Before I move to the various political pressures on this endeavour, I should like to explain the theory behind the use of hydrogen peroxide and ozone and their effectiveness against viruses and bacteria. It seems that these groups of organisms evolved during a time in Earth's history when there was much less oxygen in the atmosphere than occurs naturally at present. I say "naturally" because in polluted urban environments the figure can be reduced to as low as 11 per cent. In nature, oxygen forms about 20 per cent. of the content of the atmosphere. The effect of adding oxygen to the bloodstream in these ways is to create an oxygen-rich environment which is hostile to viruses and bacteria. The additional oxygen oxidises the foreign proteins that it encounters, which form the cell walls and fragments of the micro-organism. But in the doses recommended by doctors with experience in this field it does not attack the body's own proteins.
The effect that I am describing is similar to, but far greater than, the effect of lots of exercise, fresh air, and fresh fruit and vegetables, which also contain hydrogen peroxide. So, in fact, do our bodies. Hydrogen peroxide is a naturally occurring body product used by the white blood cells to destroy pathogens.
Originating in Germany in the 19th century, oxygen therapies are now used in many countries as an effective treatment for AIDS sufferers, many thousands of whom have had their death sentences reversed by these treatments. If I am right, how is it that what I am saying is probably new to most of your Lordships? If I am right, why is anyone still dying of AIDS?
The meetings that I mentioned with the Minister filled me with despair. Hydrogen peroxide is, as I have pointed out, a naturally occurring body product. It is also produced very cheaply by means of a very simple chemical process. The literature is in the public domain and is available to anyone who wants to know. Incidentally, there is no case of anyone being harmed by the sort of doses that are currently advocated by experienced practitioners. I should add that, for a condition as serious as AIDS, treatment by a qualified medical person with experience of oxygen therapies is obviously essential.
Hydrogen peroxide is what is known in the drug trade and in the Department of Health as an "orphan drug". What is an orphan drug? It is a product that might be of great benefit to mankind but which does not have the opportunity to prove itself for one reason and one reason only; namely, there is no money in it. I am not being fanciful or extreme in saying that. That is what I and colleagues who are interested in this matter were told by Health Department officials at both meetings.
One medically qualified official was incredulous that a product could be so beneficial and yet not have its medical benefit matched by commensurate commercial opportunity. That is incredible. She told us that, if it was so good, it must be commercially viable to spend the £100,000 plus that is required for clinical trials. The fact 744 is that it is not. One company that produces hydrogen peroxide has calculated that it would take 18 years to recoup the investment incurred doing the clinical trial.
The pharmaceutical industry spends millions of pounds every year on public relations. One company even took the trouble to send me the report of a trial that it had carried out to prove that wholemeal bread was no better than soggy white bread. It is not only that there is no money to be made following successful clinical trials; the main problem, I submit, is that the legal drug industry is worried that something as cheap as hydrogen peroxide would cut into profits currently earned from products that would be rendered unnecessary if it were properly investigated and found to be effective.
In my view, the evidence in favour is so compelling that, in refusing to investigate the possibilities for saving lives and improving the health of AIDS and HIV sufferers, the Government bear a heavy responsibility for the continuing deaths and reduced quality of life of these patients. Any investigation must include medically qualified people who have experience of these treatments. The noble Lord, Lord Colwyn, will be aware that the European authorities are clamping down on hydrogen peroxide products in the dental profession. I rather suspect that that is coming from the same source as other restrictions on natural health products.
We may be in a situation where the medical profession dares not investigate this matter properly because the political implications of having failed to do so earlier are too horrible to contemplate. I can only say to the Minister that I am sure that people who are affected or who have been affected by the loss of friends or relatives will welcome any initiative which saves lives in the future.
Before I leave the specific problem of AIDS and HIV, there is one final matter that I should like to mention. The question of the re-use and sharing of hypodermic syringes is a very important issue. I have been told that all hypodermics are marked with a warning that they should be used only once. If that is true, this, for people whose judgment has been impaired by previous drug use on the present imperative of "getting a fix", will have the same effect as the government health warning has on those of your Lordships who are smokers.
Yet it is very simple to produce syringes that are impossible to use for a second time. Several patents have been taken out for such syringes. My information is that after the retooling costs the cost per syringe is not significantly more than for existing syringes. You would think that manufacturers would see the commercial benefit of non-reusable syringes. Why has the Government not made it illegal to sell, produce or import reusable syringes?
I said at the beginning that I regarded today's debate as really two debates and the second matter I want to talk about is another aspect of the drugs issue relating to the health of drug users. I hesitate to use the word "misusers" because the distinction between legal and illegal drugs has become blurred over the past century or so. Not only are prescription drugs stolen and traded by addicts, but several of the major street drugs started 745 life as prescription drugs. I am thinking here of heroin, cocaine, morphine, amphetamines and LSD which were all originally prescription drugs.
I want to talk about one aspect of rehabilitation, leaving it to others to go into details about what one speaker called "the interstices of policy". I want to look at one particular aspect of which I have some experience, having worked for a time with former drug addicts at a rehabilitation centre which uses the Narconon programme, developed by the American humanitarian and philosopher Mr. Ron Hubbard. Almost certainly, his single most important contribution to the science of drug rehabilitation was the discovery that drug residues lodge and persist in the fatty tissues of the body and re-stimulate the craving which a person has for his drugs. Other pollutants such as PCBs also remain in the body in that way.
The detoxification period at a rehabilitation centre using the Narconon programme is followed by a number of days, a part of each day being spent on a programme of exercise, sauna and food supplements—vitamins, minerals and oils. It has now been established beyond all doubt that that regimen enables the body to eliminate the drug and other residues from the tissues and so eliminate the physical source of any continued craving. The physical aspect is by no means the whole story and the persons undergoing the programme will also examine in detail the ethical basis of their lives, the way they relate to others and the original reason why they started taking drugs.
The sauna programme is carried out under the general supervision of a medical doctor, who examines all participants before they start. It has also been used to good effect by medical doctors who specialise in treating patients whose bodies have been contaminated by industrial chemicals such as dioxin and PCBs.
Recently, technical advances in equipment used in measuring small concentrations of chemicals in sweat and urine have made it possible to monitor the amounts which are released from the body during the sauna programme. It has also been found that, having completed the programme, the levels of drugs or unwanted chemicals in the body continue to reduce, as, once mobilised, they continue to be released.
I suggest that any drug rehabilitation method or programme which does not use the sauna programme faces an uphill struggle in the battle to free drug addicts from their addiction.
The importance of food supplements in the treatment of addiction is shown by the experience of Narconon staff, who found that every person coming in with a drug problem was deficient to some degree in certain vitamins and minerals. Those deficiencies themselves seem to be the root of many personality and emotional difficulties that these individuals experience and, when remedied, there is immediate improvement in their viewpoint on life. For example, it appears that the very experience of "getting high" on any drug, whether it be alcohol, stimulants, depressants, barbiturates, hallucinogenics or whatever, depletes vitamin B1 significantly, vitamin B3, vitamin C, calcium and magnesium, as well as many others in varying amounts. When large supplementation of those is administered 746 either orally or intravenously to new arrivals, whether in withdrawal or having taken drugs just recently, their ability to reason and to view their surroundings and problems more calmly—in other words to function as human beings—shows rapid improvement. All the participants are examined by highly competent and up-to-date nutritional specialists.
I recall a conversation that I had some months ago with the noble Lord, Lord Mancroft, about whether it is possible to cure drug and alcohol addiction. It may be an almost philosophical point, because one could say that, if someone is not using a drug, then he is cured. But the noble Lord's viewpoint was very definitely that there is no cure. The view of people with experience at Narconon is that there is a cure. When I said that I knew people who had been through the Narconon programme and were cured, he said that in that case they cannot have been addicts. I found that a rather circular piece of logic.
I know that the noble Lord helps to promote the Minnesota Method, based on the twelve steps. I know that it does a lot of good for a huge number of people. But I have a philosophical disagreement with it; namely, that the first of the twelve steps states that one is powerless in the face of one's addiction; in other words, that there is no cure. That is simply not true, and especially not true if one is able to remove the drug residues from the body, which is exactly what is achieved by the Narconon sauna programme. As I have already explained, that process is now quite simple to measure.
The Government are interested in value for money. Narconon unquestionably has the best long-term success rate of any rehabilitation programme in the world. The reason, apart from the skill and dedication of the staff, is the sauna programme. I am happy to be able to announce that Narconon is now able and prepared to train other rehabilitation professionals to deliver either the whole Narconon programme, or just the sauna detoxification part of it, to improve the effectiveness of their work.
As part of the Government's ongoing evaluation of different rehabilitation programmes, the Minister may like to study the results of the many Narconon centres throughout Europe, including the one in the south of England. She will find them unsurpassed. She will find that there is a cure for addiction and that it is available and achievable. There is, in fact, no need for anyone who wants to be cured of his addiction to be unable to be so. The word is getting around the drug taking community: "If you really want to get off drugs, go to Narconon." That is not just because of the sauna detox. Former addicts whom I have met at Narconon say that there is a qualitative difference from many other rehabs in the way they are treated as individuals. They are never invalidated; no one evaluates their experience for them; they are enabled to find their own way out of their problems.
I have focused quite deliberately on the one rehabilitation programme with which I am familiar. We have an immense problem with drug-taking and I have spoken about one very effective solution to one aspect of the problem. I do not mean to discount the 747 enormously valuable and dedicated work done by those who work in rehabilitation centres up and down the country.
I end by saying that I wish the Government well with their co-ordinated strategy. Any contribution that I or Narconon can make to that success will be gladly made.
§ 6.8 p.m.
§ Lord Moyne
My Lords, I, too, congratulate the Government on this document, and I do not congratulate them lightly. Far more do I congratulate my noble friend Lord Mancroft on his epoch-making speech. It should be studied with the very greatest care by all the authorities concerned.
I shall strike a more sombre note, though in the same direction. It has been pointed out by several noble Lords that the war against drugs looks very like prohibition in the United States. It is a repetition on a world wide scale of that gigantic, failed experiment. The fact is that laws against drugs make them expensive and therefore profitable, as the noble Lord, Lord Rea, among others, pointed out. Laws against drugs confine the trade in drugs to those who are willing to break the law and therefore confine that lucrative trade to criminals. That is like adding two and two. I ask noble Lords' forgiveness for speaking in such an elementary fashion. Nevertheless, it is reasoning which seems to be widely ignored.
I make two predictions. Despite the laws, drug-taking has expanded and is expanding explosively. Of my predictions one is certain and the other probable. My certain prediction is that drugs will be legalised in all major countries within 20 years, and in the case of marijuana, within 10 years. My probable prediction is that within 40 years the President of the United States will be the grandson of a drug baron, as President Kennedy was the grandson of a bootlegger.
The most depressing aspect of the Green Paper, much of which is so good, is the way in which it excludes all serious discussion as to whether it is right that drugs should remain illegal. Before turning to that matter I want to make clear that I am not advocating legalisation at this moment. One—though one only—of the arguments against it in Annex D is absolutely decisive: that is, that drugs are not a British problem alone but an international one. Unilateral legalisation would attract addicts and traffickers to this country as a pot of jam attracts wasps. The Dutch experience has not been good. Legalisation, when it comes—not "if' it comes—will be by international agreement and will take many years to achieve. However, it is up to us in this country to start discussions on those lines.
Much of the rest of Annex D, as was pointed out, can only be described as boneheaded. Paragraph D3 has already been mocked a little; it suggests an analogy between decriminalising drugs and allowing armed robbery. That analogy is not only false, but it is also callow. It would be scouted in any fifth-form debating society. I am sorry for the authors of the document if they cannot see the difference between robbing a man 748 of something he dearly wishes to retain and providing someone with a commodity he desperately wants to have.
Similarly, in paragraph D5 the document admits that cheaper drugs may mean that users would commit less crime to feed their habit. But then adds that,the benefit in terms of reduced crime would be heavily outweighed by the human costs of widely increased drug dependence".Would it indeed? That can be contested on both moral and practical grounds. The moral point is that the person mugged by a desperate addict is an involuntary victim; the taker of a drug has chosen to take it. The practical points are perhaps more important. There are many grounds for thinking that drugs would do far less harm if they were legal, and the noble Lord, Lord Rea, pointed out some of them. But let us look at them.
Heroin is mainly injected because, and only because, it is expensive. Legalisation would therefore cut, and possibly even eliminate, the problem of infected needles, severing the link between drugs misuse and AIDS. Again, if drugs were legal people would seek necessary help far earlier and far more openly. Again, there is at present a class of drug abuser whose experience more or less foreshadows what will be the case after legalisation; namely, the children of the rich. I am sorry to go into the class matter but it is important. Admittedly this point is anecdotal. A friend of mine in his 40s told me that 20 or so of his acquaintances, when they were young, took hard drugs. Only two of them suffered permanently after 20 years; the rest are all right. It is not drugs alone, but drugs plus deprivation that is the problem.
Again, legal drugs would be subject to quality control, as the noble Lord, Lord Rea, pointed out, but one cannot tell the truth too often. People would know what they were taking and they would not be killed by drugs of an unaccustomed strength or adulterated with poisons. Finally, resources not spent on enforcement would be available to finance care and treatment of those who required it. That could treble, without any extra cost to the Exchequer, the amount devoted to care of users.
Very little has been said—unexpectedly little—about the difference between different drugs. As I said, marijuana is probably the one that will be legalised first because it is the one that is most widely used and, on the whole, experience shows to be the least harmful. The Green Paper makes no distinction at all between soft and hard drugs. In that, it is not only out of touch with the facts but out of touch with the thinking in most other countries. It emerged in a recent French television programme that over 50 per cent. of the French population had tried marijuana. That is backed by the figures of the noble Lord, Lord Rea, in relation to parts of this country. The studio audience in that programme, according to my informant, exploded with laughter when some of the more lurid allegations against marijuana were mentioned.
That brings me to the important matter of educating young people on the facts about drugs. In that regard an enormous amount of care must be exercised. And in this at least the Green Paper is sensible and honest. On page 17 it admits that,Many drug misusers do not suffer serious illness".749 Most official propaganda up to this date has not admitted that; but it is a fact and it is good that all facts should come out. If then, as it says on page 27, pupils continue to be taught about the harmful effects of drugs, it is important not to do that in such a way as to contradict the personal experience of those who know drug users who happen to be healthy, otherwise the campaign is totally discredited. A recent report tells of an Arsenal football star—and in order to be a football star he must be a considerable athlete—who is a cocaine addict. Drug education must cope with cases like that. As the All-Party Parliamentary Group on AIDS puts it,This is an area where teachers are likely to know less than their pupils"—and they can say that again!
The Green Paper contains a number of accounts of local successes in the war against drugs, and in the context, and temporarily, they are extremely heartening. The cleaning up of the King's Cross area is perhaps the best example. However, those examples remind me of nothing so much as the real and substantial successes of the former South African Government against the African National Congress. King Canute's courtiers, too, could probably point to areas on the seashore where rocks had temporarily dammed the incoming tide. The drugs war is similarly unwinnable. Let us hope that that is recognised internationally before too many lives are damaged, too much treasure is expended and too many objectionable fortunes are made in this counter-productive effort.
§ 6.18 p.m.
§ Lord Russell of Liverpool
My Lords, I must declare three interests. First, I am a joint secretary of the All-Party Group on Drugs Misuse, though I do not speak in that formal capacity this evening. Any views I give are my own but they stem directly from the somewhat mixed experience of sitting in on that group's deliberations for the past eight or nine years, most of which was profoundly depressing.
Secondly, I am the chairman of a drug education charity called Life Education Centres. We teach about 250,000 children in primary schools in the United Kingdom. Thirdly, as the noble Baroness, Lady Cumberlege, mentioned, the Department for Education was unwise enough to invite me to chair the series of four conferences to be held around England in the New Year to discuss how to get drug education kick-started properly in schools where it is not already present. The noble Baroness inadvertently promoted me to the rank of an Earl, which was extremely kind of her. But, as I explained to an American colleague a couple of weeks ago in New York, I am a Baron and firmly at the bottom of the pile where I belong.
I should like to speak this evening primarily about the Green Paper. That does not in any way denigrate the fact that it is World AIDS Day today, but in the interests of economy, focus and timing, I shall have to leave that aside. The educational element in trying to do something about continuing the success we have had so far in this country is extremely important, particularly in light of 750 the rather distressing fact that the largest increase in HIV prevalence in this country is in the heterosexual population.
It is an unaccustomed experience for me, as a Cross-Bencher, with my voting record during the years of the current Conservative Administration, to stand here and be able to praise something that the Government have done, but on the whole I think that the Green Paper is remarkably good. In many ways, as other speakers have said, it is a landmark inasmuch as a great many different areas of government have got together and gone through the not inconsiderable discipline of trying to agree with one another on something. It demonstrates the value of focus and of applied and, above all, co-ordinated data collection, and in particular the application of a considerable degree of Civil Service intellect to what is a pretty intractable problem.
I would particularly like to thank by name a lady called Sue Street, who is at the head of the Central Drugs Co-ordination Unit. She and her extremely capable small team have achieved more in the past nine months than governments of any political persuasion in this country for the past 30 years in terms of really getting their minds around the myriad aspects of the drug problem. We owe Sue Street and her team a considerable debt.
Secondly, it would be churlish of me to deny that both the Lord President of the Council and the Prime Minister have been a considerable force behind giving Sue Street and her team the authority to go and kick behind with the right degree of force and application.
There are three themes about which I particularly want to speak. The first is the overwhelming need for top-level co-ordination if we are to continue to make any headway in dealing with this problem. Secondly, we must be realistic in understanding the timescale of what it is we are embarking upon. Thirdly, and more specifically, there is a vital need for some very dedicated and applied training in certain areas.
Co-ordination is something we have been spectacularly bad at in the past. The level of miscomprehension and incomprehension between the different departments of state has been a joy to behold at times, but on most occasions it has been rather depressing and distressing. The ministerial sub-committee on the misuse of drugs, set up some seven or eight years ago, has made some progress but, by and large, has been fairly spectacularly unsuccessful. What it needs, and what I am glad to say it has had more recently, is, first, a fairly big-hitting chairman who carries some weight at the Cabinet table and, secondly, and critically—I come back to my praise of Sue Street and her team—some high quality, co-ordinated information from across all of the departments concerned, including a look at what is happening internationally, to help the sub-committee take some of the strategic and funding decisions which need to be taken. It would be tragic if we were to lose the considerable reservoir of knowledge built up in this rather short, eight-month period in the Central Drugs Co-ordination Unit. I urge the Government to think carefully about how that can be conserved and added to.
751 I know that no decision has been taken on what the future of the unit should be, but there is a very strong case for saying that the ministerial sub-committee should have a small, dedicated, highly specialised team which looks right the way across the problem to advise it. Otherwise, we shall start falling into our previous errors, which would be a great pity.
There are all kinds of sensitive issues that still have to be dealt with at the ministerial sub-committee level: sensitive questions such as what should be the role of health education authorities; what is the exact role of the Advisory Council on the Misuse of Drugs; what should be the role and funding of SCODA. Those are all quite major strategic issues which are broader than the remit of any particular department. We need a cross-curricular approach to decide how best to deal with these issues.
What Sue Street and her team have shown is, first, how much we know but, secondly, and obversely, how very little we know. One has seen that demonstrated in the range of views that we have heard today. This debate thrives on a certain amount of fact and, by and large, on a rather overwhelming residue of ignorance. It is possible for people to propound all kinds of interesting ideas. Most of us have to listen with a degree of politeness, because quite frankly we do not have enough information to know whether to laugh or to cry. All I would say is that if noble Lords wish to find out more about one or two of the remedies proposed this evening—I think in particular of the second remedy proposed by the noble Lord, Lord McNair—if they care to apply to the ISDD library to see what information it has, they will find that yes, indeed, Narconon was set up by the late Ron Hubbard. But it also demonstrates and points out the fact that Ron Hubbard was the founder of what is known as the Church of Scientology.
§ Lord McNair
My Lords, among his many achievements L. Ron Hubbard did not, in fact, found the Church of Scientology. What information ISDD may have about Narconon is probably very out of date. If the noble Lord would like to find out about Narconon I suggest that he goes to Narconon and sees the work it is doing.
§ Lord Russell of Liverpool
My Lords, I thank the noble Lord for that intervention. To do that I would need to go to the headquarters of the Church of Scientology in this country, which is located in East Grinstead. Perhaps my information is out of date but I am sure that I shall put in a suggestion to the ISDD that it gets more up-to-date information. I shall be interested to see what it has to say.
The second theme I want to talk about is the timescale. The noble Lord, Lord Mancroft, spoke in some detail about the philosophy underlying what the Green Paper says in recognising that trying to focus on supply without doing something about reducing demand is ultimately self-defeating. If there is one big idea that runs through the Green Paper it is that there is no single response to trying to deal with drugs. It is no use trying to skew it too far in demand reduction and it is no use trying to skew it too far the other way in trying to choke 752 off the supply. The answer must lie somewhere in the middle. However, we must do a great deal more, rather more effectively, than we have in the past.
While tobacco is not a perfect role model for what can be achieved, if one looks at what has happened over the past 25 years to the demand reduction for tobacco products, it serves as a kind of goal or model for what one might seek to achieve in trying to make more young people in particular realise that starting to experiment with drugs is a somewhat dangerous and stupid thing to do. The reason for the reduction in tobacco consumption is not that everyone has jumped up and down and said, "No, you should not do it"; it is that a great many people now recognise that there are some facts involved in tobacco consumption to do with the real harm it does as well as the anti-social side effects. Those facts have gradually permeated the consciousness of most young people. That is not to say they will not try it, but the figures show that a great many people who start experimenting with tobacco, like me, at the age of about 14, have actually given it up by the age of 25 or 26. If we can achieve that kind of success with some of the people who are dabbling in drugs, that is a good goal to aim for.
Above all, we are embarking on a very long haul. I am making an appeal to any politicians of any party who are looking at a drugs strategy, or any element of it, to recognise that to look for short-term achievements, two-year or five-year paybacks—unless one is being highly specific about individual programmes—will ultimately be self-defeating and extremely depressing. The problem is not something which responds quickly to treatment. It takes many years to permeate the consciousness. Any party that comes in and propagates a quick fix should be treated with due disrespect.
The last point I wish to concentrate on is training. The levels of ignorance shown by some of the so-called experts who have come before the all-party drugs misuse group are quite staggering. That ranges from ministerial level, through senior departmental officials, to some of the so-called experts out in the field. Quite understandably, drugs are a very distasteful subject to a great many people. Most people do not really wish to know about the problem and the few politicians in this and the other place who have concerned themselves with the question have often done so as a direct result of their own immediate family being tragically affected by exposure to drugs. It is not a subject which most of us tend to go looking for and that is perfectly understandable.
In trying to implement some of the programmes which the Government are recommending, there is a very real need for some very careful thought about training. The trainers need to be trained. Many departmental officials need to be trained. Certainly, the officials in Ofsted who are to be charged with deciding whether or not any individual school has an effective drug education programme need to be trained how to recognise a good scheme from a mediocre or bad one. The people involved in deciding how the GEST grant should be used for training teachers also need to know enough about the different kinds of training available to be able to give guidance on what is a sensible way to 753 be trained and a less sensible way to be trained. At the moment the level of knowledge in those areas is quite low.
I would like briefly to return to what I said at the beginning about the need for co-ordination. The overwhelming theme and success of the Green Paper comes from the level of co-ordination that went into its creation. If we forget that, and if each department which is charged with doing things in the Green Paper, or in the White Paper when it ultimately appears, goes off in an individual direction, they will all end up quite a considerable distance from one another and a great deal of the good that the Green Paper has created will be dissipated.
On balance, I believe that the Government have done remarkably well thus far. In proof, as I said, I have had recent truck with officials in the Department for Education. They are all in a mild state of shock because the draft circular on drug prevention in schools, which Mrs. Shephard announced a few weeks ago, has, to the astonishment of herself, her Ministers and officials, met with almost universal approbation, a very unusual experience for officials of that department. It was an experience which initially they found rather uncomfortable but which they are now beginning to quite enjoy. I believe that the Government have made quite a good start, but there is a very long way to go. Whether the work is carried on by this Government or another, I wish them well.
§ 6.34 p.m.
The Viscount of Falkland
My Lords, what a debate we are having! It is certainly not what I was expecting. It has been absolutely riveting so far and we still have the speeches of the two noble Baronesses to come. We have had a lot of expertise, humour, innovative thought and some curiosity. I rise to speak mainly for myself although I speak from the Front Bench.
I have one duty to clear straightaway because I have been requested to do so by one particular noble Lord. I wish to clear the air as to where the Liberal Democrats actually stand as regards drugs because there seems to be some misunderstanding due, I believe, in some part to media excitement; namely, that the Liberal Democrat Party voted at their conference in September at Brighton not to legalise cannabis. That is quite inaccurate. What they voted for was the establishment of a Royal Commission to consider the potential decriminalisation—there is a nuance there—of cannabis along with other measures to combat both drug misuse and the crime which all too often goes with it. I have done my party duty.
I stand here as one who takes a great interest in the problems which we have been discussing today. I am a vice-chairman of the all-party group on alcohol misuse. 'It is one of the facts of parliamentary work—it goes further than that—that alcohol and drugs are treated separately in areas where they should be treated much more closely together. That has been referred to by one or two noble Lords today.
There are of course differences. Everybody knows—even the youngest of school children probably now knows—that mood changing substances have existed in 754 most societies since the beginning of history. Nothing much has changed in this country except the scale of the use of addictive substances. There is the cultural acceptance of alcohol which makes it legal to buy and consume whereas drugs are not legal to buy, consume or to trade. I have myself no particular view.; about decriminalisation, but I go along with my party in believing that the whole question needs to be examined in a much more open way in order that we can all be sure that all avenues have been discussed without a kind of confrontational attitude.
Although the Green Paper is admirable and worthy and a very good starting point, as noble Lords have said, the part which was referred to in particular by the noble Lord, Lord Mancroft; namely D.3 in Annex D at the back, lets the whole paper down. It is the most absurd and disgraceful piece of logical thinking that I have come across in any document which has the authority of government in the 11 years that I have been here. It would be a disgrace to a 10 year-old to come up with reason of that kind. I hope that the noble Baroness will look at it and comment on it. I hope that she will dissociate herself from it and that someone will get rapped over the knuckles for it. That is unlikely, but we can hope.
I return to the noble Lord, Lord Mancroft. It has been an unusual afternoon. In the 11 years I have been here I believe that he made the best—certainly Conservative—Back-Bench speech that I have heard in this House. It is probably the best Back-Bench speech that I have heard in this House on any subject. He spoke for about 28 minutes. One noble Baroness on the Front Bench was looking somewhat apprehensive, but she seemed to be cheered by the fact that we were all absolutely frozen in our seats with attention at what the noble Lord was saying. I felt as though I were a late 18th century MP in the House of Commons when Charles James Fox was speaking. He spoke for a great deal longer than the noble Lord. When Charles James Fox gave sign that he might be flagging after several hours, Members shouted "Hear him! Hear him!" in order to keep him speaking. I felt like emulating that great Whig orator.
I turn to alcohol for a moment. Without doubt alcohol is today the most dangerous drug in our society. It creates more death, more illness, more absenteeism and is responsible for more wife-battering, more child abuse and more traffic accidents. You name it, alcohol is responsible for it. I have been trying for many years to change the way in which alcohol is discussed in our society, but it is impossible. We all know why—it is because too many vested interests are involved. I should like alcohol to be discussed in the same dispassionate and objective way as we are attempting to discuss the drugs problem. That is not to say that I want drugs to be regarded in the same way as alcohol. I do not agree with those noble Lords who have said that drugs are not harmful in society. I think that drugs are extremely harmful. In fact, I object to the term "drug misuse". I should prefer to use the phrase "drug use" wherever the term "drug misuse" is used.
I do not believe that there can be sensible drinking. In fact, I have tangled with the chairman of the Portman Group, Dr. Rae, on that subject. I do not believe that 755 such a thing as sensible drinking exists. It is a contradiction in terms. Therefore, I do not believe that there can be any "sensible" use of drugs. The aim of all of us should be to reduce the use of drugs, particularly among the young.
When people smoke cannabis or take heroin, opiates or any of the prescription drugs, they generally do not go out and behave rowdily on a Saturday night or assault women, although some of the drugs that are now available, particularly crack, have an association with sexual activity, but I shall not go into that.
I go along with the document's aims. There is nothing terribly original in it, but why should there be? It is meant to stimulate discussion, thought and suggestions before a White Paper comes out. Apart from the particular offending piece to which I have already referred, I am quite sure from the general tone of the Green Paper that we shall be able to get together with Government to improve our approach and to move closer to finding a solution to a lot of the problems. I direct anyone who doubts whether there is a problem to the figures that were quoted about the Scottish experience in yesterday's Guardian. Scotland's experience is not all that different from ours except that some drugs are more popular there than here. According to a recent in-depth survey of men aged between 20 and 24, 44 per cent. have taken or are taking drugs, and 33 per cent. of females between the ages of 16 and 19 are doing likewise. That in itself indicates that there is a serious problem.
I have a number of children and I have spent many years with my fingers crossed. So far I have been lucky, as far as I know. I am quite sure that my elder children have tried some drug or another at some time. They have all attended schools where there have been well-known scandals with drugs. Indeed, one attended the school of which the head was the aforesaid Dr. Rae before he joined the Portman Group. He would not deny that there was a problem there. Happily, when my son was at Westminster he was not involved in that. I sometimes think that because the school had such a bookish attitude towards sport, he rebelled against that and did a lot of athletic things in order to upset Dr. Rae and the masters. That did him no harm and he is a healthy, youngish man of 31 today.
On the subject of education, I have intervened on several occasions at my children's schools to complain bitterly about the quality of their drug and alcohol advice. The main problem is always that the wrong people are talking about it. They do not have either the respect or the interest of the children. A school that my daughter attended—unfortunately for a shortish period 'only because it closed due to lack of funds—had very good people coming in to talk about drugs. They were all ex-addicts who had a teaching gift. Wherever possible, people who have a gift for teaching and who have been through the harrowing experience of drug addiction or alcoholism should be encouraged to come into schools. Use should be made of them because many are extremely willing to help.
756 Nothing is more cheering than to see successful education. Along with a number of other noble Lords, I am a patron of an East End charity for the "re-education" of homeless people who have reached the end of the road. They have had appalling lives and have lost everything. That re-education, which is an expensive and long process, has had extraordinary results. It is most encouraging to see someone's life being turned round. It can be done, but it is expensive and painstaking and requires a lot of dedication. Exactly the same thing will have to happen in schools and universities as regards drugs.
Turning to the social aspect, many people who are lucky enough to have escaped any family problem or despair over drugs think that it is something that will never happen to them. That applies particularly to people in more affluent circumstances. I know of two men, both of whom were exceptional athletes, who became crack addicts. One was a multi-millionaire who made a large fortune in the 1970s. He lost everything as a result of his cocaine and crack habit. He is now undergoing treatment. As a matter of fact, he got into drugs through his addiction to sex. It was not a drug addiction originally. He had a problem with sex and went to prostitutes and call girls who introduced him to drugs. That is not an uncommon series of events when such fast-acting, extremely powerful and dangerous drugs are involved. If we are to teach about drugs, it is necessary to look at their range of ill effects throughout the whole of society. We should not be talking only about children and prisoners. Everybody is vulnerable for one reason or another. That is why we need to know more about it. We need to be more open and less confrontational in the way in which we discuss drugs.
On law enforcement, it is admitted in the United States that about 10 per cent. of the drugs coming on to the market are intercepted. But that leaves 90 per cent. unintercepted. The size of the problem is obvious. I have no reason to think that our enforcement or our success in terms of Customs and the police is any better. All praise to the police and Customs officers who had such a large cannabis haul recently. However, I must ask whether it will really make a great deal of difference if we have a number of such cannabis hauls. As many noble Lords have said, the police and Customs are fighting a losing battle.
I do not want to go on any longer. We have had a wonderful debate and I am still thinking about what the noble Lord, Lord Mancroft, said. All of us should read what he said carefully. He has brought a lot of expertise and experience to the subject, and has taken a fresh look at a lot of the things about which we may have made some wrong assumptions. I hope that the Government, too, will read his words.
I should like to say something about a matter that is not in the Green Paper. Indeed, perhaps it should not be there. What is the cause of the escalating drug use? I do not know the answer, but I suggest that one reason might be the shocking provision of housing in this country, the lack of a proper provision of education in deprived areas and the lack of something for young people to do. We all know what happens if we leave young people to their own devices. It happened to me 757 at one stage. I was left pretty well unattended and got into what seemed to be the most awful trouble. However, I came from a generation which, when I look back, was generally rather innocent. We thought that stealing apples was a dangerous activity, so how can I talk to my young and pontificate about drugs? Generally, I think that it is a question of the environment in which people live and grow. We need better housing and better education in this country. We need to take a serious look at the employment of young people.
Our problems are not yet on the level of the French. There is absolutely no disagreement about the fact that the French have two major problems: one is unemployment and the other is AIDS. I will not go into AIDS because that is a subject of which I know very little, but I have been very interested to hear other noble Lords in this debate. Perhaps I may just say that it has been a wonderful debate. I have enjoyed it enormously. I have learnt a lot and I hope to learn even more in the two remaining speeches that we are going to hear. Like other noble Lords, I look forward to the White Paper.
§ 6.49 p.m.
§ Baroness Mallalieu
My Lords, this could have been a depressing debate but I do not think that it has been. From all sides of the House there have been indications that discussion on how to deal with the problem is at last beginning to expand beyond current thinking, current wisdom and attempts at solutions which have not worked. There is no doubt at all—no speaker has suggested otherwise—that we are currently losing the drugs battle. A number of speakers have suggested that it is one which cannot be won. A wider variety of drugs than ever before is readily available to our young people and indeed to anyone else who takes the trouble to look for them. There is a steady and alarming increase in the number of registered addicts, many of them HIV-positive or suffering from AIDS.
Drugs are now, I understand, the major single contributing factor to the crime figures. And the position is worsening, not improving. The problem is not just ours; it is world wide, as the noble Lord, Lord Moyne, said. No one has yet found the right answer. I thank the Minister for introducing the debate and I want at the outset from these Benches to welcome the consultation document. I do so with particular and real enthusiasm in one important respect. Its general approach, if different government departments, particularly the Home Office, Education and Health, are at last to adopt a joint approach, is one that we on this side of the House applaud. If achieved, that will be a major advance because, too often and in too many ways, some of which I shall come to shortly, the fact that the Home Office sees drug users as criminals hampers, stifles and even stamps on initiatives in medical practice and treatment 'generally which the Department of Health, seeing drug users primarily as patients, should be trying but feels that it cannot try. To overcome that fundamental difference of approach would, I believe, lead to a great deal being achieved.
My criticism and my fear about the paper is that it is couched in language and indeed clings to many of the approaches which have been tried and have not 758 succeeded. It in a sense reinforces the usual conventions and the usual methods as being effectively the right approach and one from which we should not even think of deviating. If we are to make any real progress in this battle we have to dare to think the unthinkable. We have to tackle the problem from the realities in 1994 and not from wishful thinking.
We would all of us wish to think it possible to stop, or virtually stop, all illegal drugs entering Britain. But it is not possible. We would all of us wish to see those who use drugs weaned off them. But some of them cannot be and never will be, or at least not in the foreseeable future. All of us, especially those with children, would like to see drugs cleared from our schools, from the streets and from the clubs that our children in particular frequent. But the reality is that those drugs are there; they are entrenched; and they are likely to remain there in the foreseeable future. We have to tackle that reality with realism.
I hope that the consultation period will not in the end prove to be a simple rejigging of old policies which have not met the problem. I hope that we can use it as an opportunity to look at radical alternatives and to innovate instead of taking the safe routes yet again. I simply ask this: can we in fact worsen the position if we do? I suggest that we cannot.
Many noble Lords have spoken from a background of great experience, particularly in relation to education, treatment and health. My background is that of a criminal lawyer. The matters I should like to raise, I hope briefly, arise from direct and recent experiences I have had in this area which fall largely within the province of the Home Office, in relation to which the noble Baroness, Lady Blatch, is, I understand, to reply.
The noble Lord, Lord Gisborough, referred to the importation of heroin and cocaine, which of course are not produced here. We have not managed to find any satisfactory way of stopping large quantities of those drugs being illegally imported. The drugs come here because there is a lucrative market for them; that makes it worth the risk being taken by the smugglers. The prison sentences now being imposed for drugs offences in reality exceed those served for murder.
The drug trafficking provisions passed through this House in strengthened form relatively recently mean that those who are caught can be stripped effectively of all their assets. But they have not stopped consignments being sent and have not stopped them getting through. It is clear that unless demand is cut a supply will continue to come. Surely we must tackle both the supply and the demand. As to supply, am I, apart from the noble Lord, Lord Rea, who mentioned it, alone in feeling alarm at the announcement made yesterday that out of what I understand from the consultative document are some 800 specialist investigation staff in Customs and Excise, it is proposed over the next five years that some 550 anti-smuggling officers should lose their jobs?
§ Baroness Mallalieu
My Lords, the noble Baroness, Lady Masham, is quite correct. She too referred to the matter. I wonder, in the light of the concern voiced from 759 various sides of the House, whether the noble Baroness who is to reply will tell us why that reduction is proposed at this time. How is the vigilance of those officers to be replaced? May I also ask the noble Minister for urgent reassurance that the ability of Customs and Excise to detect and intercept consignments of dangerous drugs will not be reduced by the cutbacks?
I shall come back, if I may, to the question of demand. But a second matter of great concern is what is taking place in our prisons in relation to drugs. Three times in the last six weeks three different prisoners in three different prisons—one in Oxfordshire, one in Buckinghamshire and one in London—have told me that drugs are more readily available to them in prison than they were outside. I note that the consultative document refers to research being done and proposed to be done into the extent of drug misuse in prison. I am confident from what I have been told repeatedly that the end result of that work will be the conclusion that misuse is rampant.
I ask your Lordships for a moment to dare to think the unthinkable and to consider the options. They fall into two categories. We could, on the one hand, look at countries such as Hong Kong which, in relation to drug offenders in particular, have, with very considerable success, isolated them in a single prison. Visiting takes place through a screen so that drugs cannot be handed over. There is routine daily urine testing, and there are proper and comprehensive treatment facilities available within prison and supervision on release which would be the envy, I think, of the probation service here. Checking on curfews takes place, often several times during the course of a night. The treatment has had a measure of success and, certainly, in some cases has reduced, if not eliminated, the taking of drugs in prison.
Such measures may not be acceptable here; indeed, they may be impractical here. If that is right and if we are accepting that some drugs will be available to people within our prisons, surely the time has come to ensure that clean needles and a means of sterilisation such as bleach are available to prisoners in the inevitable circumstances of their making use of drugs and possibly injecting.
We must also surely ensure, particularly if we are taking the trouble to test people's urine to see whether they are taking drugs, that there are facilities in every prison, and not just a selection of them, where help, advice and treatment can be provided while in prison and after release. The present position in relation to drug misuse in our prisons is a scandal. I am desperately concerned that young people especially who are sent to prison should not come out with a newly acquired drug habit, and possibly HIV, as well as a criminal record. I hope that urgent action can be taken about that at the earliest possible date.
The next matter that concerns me greatly is that of needles and needle exchanges. There can be no doubt that the setting up of needle exchanges has been a great benefit not just in assisting towards a reduction in the transfer of HIV and AIDS but in affording a means of providing existing addicts with a source of advice and 760 help. But it would be wrong to overlook the fact that there are drawbacks in relation to certain of the needle exchanges. In some places, addicts have tended to congregate, to the annoyance of local residents; drug dealing has taken place in or near the premises; and, perhaps even more commonly, there is the borrowing and repaying of drugs which have been lent by one addict to another.
Those who need to be removed from the drug culture are sometimes pushed back into it by the need to go along to needle exchanges to obtain clean needles. I know of one GP who advises his drug addict patients not to go near one of London's largest needle exchanges for that reason. Other ways must be found, and readily found, to enable addicts to obtain quantities of clean needles which will prevent the passing and transmission of HIV without contact with other users.
I come back to the issue of demand, as I said I would. I had recently the experience as a barrister of appearing in front of a Home Office misuse of drugs tribunal, representing a doctor accused of irresponsible prescribing. It would be wholly wrong for me to make any comment about the specific case as the tribunal has yet to report to the Home Secretary. A number of disturbing features emerged from the evidence that I heard during the course of that hearing. First—this applies to London but may apply elsewhere, I do not know—registered addicts find it hard to discover GPs who are prepared to take them on and prescribe for them. It is virtually impossible for them to find a GP who is prepared to prescribe any quantity of injectable drugs or at the level to which hardened addicts have become accustomed.
One can readily understand the reasons. Addicts are often difficult patients. They may be devious, manipulative, and dishonest. They are certainly demanding. But what concerns me greatly is that GPs are, I believe, frightened of taking on drug addicts, because they fear the attention of the Home Office drugs inspectorate. It is easier to send addicts away. Few doctors in London will take them on, and addicts are sometimes driven into the private sector.
There are no published limits of what quantities of drugs, such as methadone, a GP may prescribe or what combinations of drugs a GP may or may not prescribe. There are guidelines. The decision is left to the individual GP's clinical judgment. Faced with a long-term heroin addict, such a doctor finds himself in an impossible position. His clinical judgment may tell him that the addict before him requires a high level of prescription or a combination. The consultative document draws attention to the fact that increasing numbers of addicts are now coming to light who are addicted to a range of drugs—not just opiates but opiates, benzodiazepines and often amphetamines, and sometimes all three.
If the GP fails to prescribe either a combination or at a level which the addict in his judgment requires he knows that the addict will merely supplement whatever prescription he gives by going to the black market and buying often impure drugs. That will bring him back with a range of health problems. What is more, the addict is likely to turn to crime as a means of funding 761 his purchase of black market drugs. If the GP prescribes as he thinks right, he may well see the addict's health improve. In some instances there is not merely health improvement but the ability to hold down a job, to form stable family relationships, and to be removed from the drug scene and the necessity to become involved in crime. The GP then attracts inevitably the attention of the Home Office drugs inspectorate whose staff is often not medically qualified who tell him that he must stop prescribing in that way.
If the GP remains adamant that he will prescribe in accordance with his clinical judgment, he may well face a Home Office tribunal with serious consequences for his career. So what is a GP to do? And what is to be done about the gap, as it seems to me, in the provision of treatment for addicts at that basic level? If there are to be limits as to what a GP may properly prescribe, surely they should be set out.
If it is felt that specialists are the only people who should be prescribing in that way and dealing with such addicts, then that specialist help must be available. Amphetamine is perhaps the largest growing addiction at the moment. Huge quantities of amphetamine are available readily and cheaply on the street, much of it seriously adulterated. There are often fatal consequences for the health of those who take it. To find a doctor—a specialist or otherwise—in central London, who is prepared to continue to prescribe clean amphetamine for an addict seriously addicted in that way is difficult if not impossible. Every patient whom a GP turns away, every patient for whom he prescribes less than the patient needs to keep him straight, is a customer for the black market and an incentive for the smuggler and drug dealer to increase their trade.
What I have learnt in the past year from the evidence I have heard before tribunals is no more than other noble Lords have spoken of this evening. Every such patient who is sent back onto the black market is put at serious health risk. It may be abscesses; it may be the consequences of unsafe injecting practices; it may be as serious as the risk of HIV. What is the doctor to do? As a GP said to me recently, "What am I to do when a prostitute who is HIV-positive and a drug addict comes to me and wants a high level of drugs prescribing for her? If I do not give her the drugs she needs, she resorts to prostitution to pay for black market drugs, and she spreads her infection. If I do, I am likely to face a Home Office drugs inspector telling me that I have done wrong and threatening me with the consequences if I do not stop."
The role of the general practitioner in the treatment of drug addicts needs proper examination. Our general practitioners must know the scope of what they may or may not do. The present uncertainty is driving many addicts onto the black market and hence into crime in order to pay for their drugs. Doctors do not know what they can do and are unwilling to take the risk. Those same patients return to the health service with serious problems.
I am anxious that this is one way in which we should examine the question of how we try to reduce demand. It may be that we should be examining realistic prescribing either by general practitioners or by 762 specialists and specialist units. As was indicated by the noble Baroness, Lady Cumberlege, and the noble Lord, Lord Russell of Liverpool, I have no doubt that education is one way forward. However, as other noble Lords said, it must be of the right kind.
Treatment was referred to by a number of noble Lords. It was perhaps the most optimistic part of the speech of the noble Lord, Lord Mancroft, and one that I would readily endorse, in particular in the voluntary sector through organisations such as Phoenix House. That organisation was referred to by the noble Baroness, Lady Masham, and I too have had some experience of it. Invaluable work is being done in providing methods of approach and treatment which are not necessarily the convention or the norm and which may not be capable of being provided by the National Health Service. I welcome the way in which the consultative document appears to recognise their role. However, I should have liked to have seen them given higher priority in the order of events.
During many of the hottest days of July this year I sat listening to what I can describe only as "hard core" drug addicts talking about their life histories. They were in their thirties and forties, which means that they came after the Rolleston Committee in the 1960s changed our approach to the way in which we prescribe to addicts. All have been through not only one drug rehabilitation or treatment scheme but perhaps as many as six or seven. Finally, they had all broken down. Some were optimistic that there might come a time when they were able to abstain from drugs. Some were resigned to never being able to do so. At present such people are relatively small in number. They are people who, unless doctors are prepared to prescribe for them—and that requires a degree of considerable bravery—have no future other than the black market and no means of paying for the treatment they need other than by resorting to crime. If in 10, 20 or 30 years' time we cannot provide for people in that category there will be an explosion in the number of others like them. They were at the forefront of those who started to take heroin and then moved on to methadone.
Various noble Lords referred to methadone maintenance programmes. It is becoming increasingly clear that a substantial body of medical opinion is coming to believe that methadone was and is more harmful than heroin which it was introduced to replace. Certainly, there is a widespread view among addicts that it is much harder to come off. I am glad to hear that the Government are looking at pilot schemes for long-term maintenance methadone but I am concerned that at this stage they have gone only as far as contemplating the possibility of long-term oral methadone.
It is clear that many of the addicts who gave evidence in the summer were addicted to the needle as much as to the drug. Some of them explained in terms that I had never previously understood why they failed to respond to treatment programmes. It was the view of all of them that the best chance for a long-term user eventually to stop taking drugs was to get into a state of good health. That can probably be done only if a doctor is sufficiently understanding to provide the addict with a supply of 763 drugs which will enable that person to put on weight, to master his personal life, to get himself a job and to "get your life together", as they put it.
If that person is asked to reduce quickly or abruptly he will find himself having to face the reality of the kind of person he has become—a person who often has lied, cheated and deceived those closest to him. More than anything else, it is the pressure of facing up to that which drives a person back to the drugs; he cannot face the reality. Where there are doctors who believe that there is some merit in a long-term methadone maintenance programme—whether it is injectable, oral or trying to reduce the injectable element, which is surely desirable—the long-term results are amazing. Often there appears to come a point when even the hardest addict becomes bored—that is a curious word to use—with taking the drugs; bored with going out and obtaining them; and bored with the degrading procedures involved. However, it is abundantly clear that one cannot force people to come off drugs before they are ready. That is one of the mistakes that our present programme is making and it is one of the reasons why there are so many instances of failure. There are so few success stories even in the specialist units.
We must be frank about the fact that our present policies have failed those who are currently addicted. What troubles me is that they have also failed the public. We are not bringing about any reduction in drug-related crime, any reduction in wrecked lives or any substantial reduction in the spread of HIV through drug taking. We owe it not only to addicts but perhaps even more to the public whose ordinary lives are affected by addicts, in particular on the receiving end of crime, to explore every avenue that is open to us. The consultation process could provide us with that chance.
As I said at the outset, I am discouraged by what appears to be a conventional approach to the problem. However, I am greatly encouraged by what has been said by noble Lords on all sides of the House. The noble Lord, Lord Russell, said that we should look for no single response. The noble Lord, Lord Kilmarnock, said that no tools or weapons should be neglected. I hope that in reply the Minister will say that the debate can be extended in the period between the publication of the Green Paper and the White Paper and that we can look further at proper long-term methadone maintenance, where that is appropriate. I hope too that we can examine the issues that have been raised by other noble Lords and look more seriously at the possibility of future legalisation of some of the drugs.
§ 7.19 p.m.
My Lords, the debate has been interesting, at times sensitive and certainly worthwhile. The Green Paper, Tackling Drugs Together, is a consultative document. It invites comments on all aspects of the proposed strategy. I know that those with responsibility for collating and considering comments will study with particular interest what has been said 764 during the course of the debate. It is also worth noting that the paper has been generally welcomed, not least today by noble Lords.
As I said, the Green Paper is a consultative document. The Government welcome comments from those involved in organisations dealing with drug issues and from the community at large. It is vital to ensure that we develop a strategy which commands maximum support. Subject to the views expressed, the strategy will be published in Spring 1995. It will not be possible in the time available to me to address all of the points raised in the course of the debate, but I will do my best to address many of them.
I had intended on behalf of my noble friend Lady Cumberlege to make reference to the precipitate ennoblement of the noble Lord, Lord Russell of Liverpool, to an earldom! He mentioned a conversation he had with an American in which the noble Lord was described as being at the bottom of the pile. That reminded me of a conversation I had with my daughter when I knew I was coming to this august place. She said to me, "Did you know, mother, you will be the lowest form of nobility"?
There has been much said about the conflict between enforcement and treatment. I certainly wish to address that point. A number of noble Lords have alluded to what they perceive to be a conflict between law enforcement on the one hand and education and treatment on the other. My noble friend Lord Mancroft spoke of either controlling the supply of drugs or the demand. The Green Paper makes clear that the Government give an overarching commitment to doing both. The paper makes it clear that we have no intention of letting up on law enforcement but also recognises that there should be a new emphasis on prevention and education. I believe that this comprehensive approach will ensure progress in meeting the aims of the Green Paper.
I take one specific point raised by the noble Lord, Lord Kilmarnock, in this respect. I can assure all noble Lords that the Green Paper proposals give the police every flexibility and encouragement to participate in local, multi-agency partnerships such as education and prevention initiatives. Many police forces are already involved in arrest referral schemes to refer drug misusers to appropriate treatment services and other similar activities.
One option the Government have ruled out is the legalisation or decriminalisation of any currently banned drug. The arguments of supporters of legalisation often centre narrowly and misleadingly on the issue of drugs and criminality. It is argued that because drug misuse involves criminal activities drug use is driven underground, prices are driven up and the illicit market thrives, together with drug related crime. Those in favour of legalisation say that if one removes drugs from the criminal law, the economic base of the traffickers will be undermined, drug taking would be less risky and therefore less attractive, prices would fall and drug-related crime would drop. But is it remotely possible that cause and effect would fall so neatly into place in real life? For a start, if the price of drugs were to fall, consumption is likely to rise. If one just looks at 765 legalisation simply from the point of view of health, the withdrawal of legal controls would be likely to have disastrous consequences. As Professor Griffith Edwards of the National Addiction Centre has pointed out, access to drugs has been proved significantly to encourage use of drugs. With legalisation therefore the number of people addicted to all kinds of drugs will be likely to increase, and with this increase in availability children and young people will inevitably be put at greater risk.
The Metropolitan Police Commissioner said,This is not simply a moral issue. It is also about the kind of society we want for our children. I do not want a society where it is acceptable to be stoned on drugs or where we pop into the cannabis shop to get the evening supply".Some people find the idea of legalisation more attractive when confined to removing controls from cannabis and the so-called soft drugs, but that solution too is flawed. Just because making something illegal encourages a black market is not an argument for legalisation. The criminal law sends important signals about what society does and does not see as acceptable and safe behaviour. Claims are made that there is little if any danger in consuming cannabis or soft drugs and of course not everyone who misuses cannabis goes on to become a heroin addict. But it is, however, frequently the case that those on hard drugs started life taking soft drugs. We should not underestimate or disregard the dangers posed by the drug. Research has suggested that there is the possibility of long-term physical or psychological harm among heavy cannabis users and the short-term effects such as light-headedness and lack of concentration are at least as serious in their implications for road safety or safety at work.
One or two countries have responded to the problem of drug misuse by turning a blind eye to the possession of drugs such as cannabis while maintaining a tough line on heroin and the other so-called hard drugs. While this may sound attractive to some, we believe that such a policy is fatally flawed. In particular it sends out a confused message to the young and to the impressionable and suggests that drugs are not harmful. Any country which flirts with this approach risks becoming a prime attraction for drug takers. The traffickers quickly move in to meet the demands for other and more dangerous drugs which in turn provides a market for surrounding countries. Let us not forget that we would be failing to honour our international obligations if we were to legalise drugs. Fortunately there is little or no support for this in the international community. Let me make it absolutely clear that this Government have no intention of legalising any currently banned drug.
We are also taking steps to deal with the misuse of drugs in prisons. Drug taking in prison can lead to violence, intimidation and of course disorder. This unnecessary misery can only be tackled head-on. The noble Lord, Lord Addington, referred to not being able to eliminate it completely. Of course we will never totally eliminate drugs from prisons but we are determined to do what we can to minimise the taking of drugs in prisons. The first step will be the introduction of mandatory drug testing. It will be one of the largest drug testing programmes ever seen in this country with 766 the random testing of up to 60,000 prisoners each year across the prison system. There will also be targeted testing of all known drug users. This will be linked to the introduction of new prison rules. Any prisoner testing positive or who refuses the test will be liable to disciplinary action which could result in 28 added days confinement or loss of privileges or indeed loss of earnings.
The prison service is, however, committed to providing help to prisoners who have misused—I think that was the point made by the noble Baroness, Lady Mallalieu—or are at risk of misusing drugs and to working with agencies in the community to provide continuity of help on release. I believe that was another point made by the noble Baroness. As part of the new strategy the range of drug treatment and education programmes in prison will be expanded. A series of new drug treatment programmes will be implemented in prisons during 1995 and the efficacy of those programmes will be monitored to ensure that the most appropriate treatments are available to meet the demands of different levels and types of drug misuse. Existing programmes will also be monitored and evaluated.
One of the particular strengths of the drug prevention initiative has been its ability to support a wide range of different treatments. The noble Baroness, Lady Jay, in an excellent speech, referred to the review of the Health Education Authority. That review is complete and it is with Ministers at the moment. I understand that an announcement will be made as soon as possible. However, I must say that the Health Education Authority does not of course deliver public education on drugs; that is for the Department of Health. On both HIV issues and drug misuse issues, we will encourage a range of agencies and expertise to contribute to all prevention programmes. It is frequently most effective to use experience close to the people, targeted to produce campaigns in that work.
The noble Baroness also talked about our commitment to the global effort. As a result of the recent Budget, the Government will, for the first time, give £2 million towards international research on HIV, and that is in addition to the £40 million given through the World Health Organisation's global programme, and to 15 African and Caribbean countries for prevention since the late 1980s.
The noble Baroness, Lady Jay, made reference to sex education in schools. She will know that she and I did battle on this over a number of hours across the Dispatch Box on a previous occasion. We have made sex education a compulsory subject—that is new—across the curriculum, not the national curriculum as the noble Baroness knows. We have provided substantial guidance. I understand that it has been welcomed and is helpful. There is now more information. It is objective information, and it is certainly more effective. As a result, we expect sex education to be more effective.
Every school must have a sex education policy. It must be discussed with parents. I believe that that is right. Information to parents will be better. There will be open discussion about the materials used. And, of 767 course, it will all be subject to inspection, which will address the quality of the sex education. That is important.
The noble Lord, Lord Addington, said something with which I shall personally take issue. He said that we should not be judgmental on these issues. I think that education has been non-judgmental for too long. I believe that we have to be judgmental. All of us who are concerned with young people have to take our courage in both hands and have a view about what is right and wrong, what is moral and immoral and what is desirable and undesirable behaviour. Without that, how are children to make sense of what is being said to them in the educational programmes?
The noble Lord, Lord Rea, said—and I hope that I have not misinterpreted him—that drug abuse affects no one but the drug abuser. I disagree with that, too. Drug abusers destroy relationships between parents and their children, between husbands and wives and often between mothers and their babies yet to be born. I am afraid that the noble Lord could not be more wrong in what he said.
§ Lord Rea
My Lords, does not the noble Baroness agree that a large part of the harm caused to families of drug abusers is not necessarily caused by the drug itself but arises from the lifestyle that drug addicts have to lead in order to finance their habit? That leads to poverty, loss of home and inability to work. They are in a vicious circle. It is not necessarily the substance itself which causes the problems.
I have known a number of people who have been able to carry on a perfectly normal family life and hold a responsible job provided their drug has been prescribed, as my noble friend Lady Mallalieu said, in a clean way at an adequate dose.
§ Baroness Blatch
My Lords, there is so much practical evidence that somebody under the influence of drugs does not behave normally. That abnormal behaviour is seriously distressing, both mentally and physically, to families, relatives and people around addicts. The point was made in passing of the difficulty which doctors face when they take drug addicts onto their books. One of the problems is the behaviour of drug addicts in surgery waiting rooms. The behaviour of drug addicts has a serious impact on the people around them.
The noble Baroness, Lady Jay, referred to the role of the voluntary sector. I should like to think that the role of the voluntary sector is implicit in much of what is contained in the Green Paper. The voluntary sector plays a vital role in prevention and education as well as in treatment and rehabilitation. My noble friend Lady Cumberlege has already mentioned some examples. There are so many others, but there is not time to enumerate them. I do not underestimate the role of the voluntary sector. We value it greatly. I am chairman of the Ministerial Group on the Voluntary Sector. I know that there is much that can be contributed by the community in that way.
768 The noble Baroness also raised the fact that the voluntary sector was not included in the Green Paper consultative committee. We are open to suggestions for altering the proposed membership of the drug action teams. The key principle to bear in mind is that the teams must be small, manageable in size, and members must be serious players who can influence the relevant policy and resource decisions of their respective organisations.
The noble Baroness went on to talk about resources in relation to the Green Paper. Over £500 million was spent in the United Kingdom and internationally last year in tackling drug misuse. The strategy focuses those resources clearly on explicit aims, objectives and priorities which all departments have agreed. It is a matter of making the most effective use of existing resources and realigning priorities in line with the aims of the strategy. We are confident that we are making available the necessary resources to do what we propose in the Green Paper.
Drug education in schools was also mentioned. Drug education in schools is covered in science lessons as part of the national curriculum. It may also form part of personal, social and health education. It is important that it is placed within the context of developing healthy lifestyles and of other substance misuse. The Department for Education has recently issued guidance for teachers for consultation. It includes advice on principles and practices to be adopted, the use of outside speakers, parental involvement and materials to be used. It reaffirms the importance of involving school governors in developing drug education policies as well as recognising how sensitive the issue is.
The Department for Education also intends to support up to 10 substantial innovative projects in drug education which will help to inform good practice in this area. I cannot remember which noble Lord referred disparagingly to the 10 innovative projects, but a number of noble Lords said, as did the noble Baroness, Lady Mallalieu, in the most recent speech, that there will not be one answer to the problem. I believe that we should try a range of interesting ideas and leave no stone unturned in looking for solutions in this respect.
A number of noble Lords referred to the concept of harm minimisation, to use the jargon. The aim of services for drug misusers should be to help people to stop taking drugs. For some misusers, however, abstinence must be a long-term goal with intermediate stages. The Green Paper does not rely on the terms "harm reduction" or "harm minimisation" because in England those terms have become loaded with confusion and dogmatic debate. What is needed is less extremist argument and more information on what works. That is why the Department of Health is commissioning pilot studies for structured methadone maintenance programmes which will offer a clear route to abstinence for those who are ready to take it. In preventive work with young people our clear objective is to discourage them from taking drugs. But the Government also attach importance to the availability of early intervention services for those who choose to take risks and need help with the consequences.
769 The noble Lord, Lord Addington, was concerned about young people rebelling against messages. I do not underestimate the harmful effects of smoking and the misuse of alcohol. The Government are concerned to make young people aware of the harmful effects of smoking and to discourage the habit. We are also concerned to encourage sensible drinking—and I have to say to the noble Viscount, Lord Falkland, that I believe that there is such a thing as sensible drinking; I indulge in it occasionally—and to reduce alcohol misuse.
The draft circular on drug prevention in schools issued for consultation by the Department for Education, covers tobacco, alcohol and volatile substance misuse as well as illegal drug misuse wherever they raise common issues for schools. I fully accept that in putting messages across to young people we must take account of how they view the problem. We must recognise that many do not see drug misuse as a problem at all. We have to acknowledge that for some young people drug taking may appear exciting. For others it is the thing to do because others are taking drugs. Our message is: know the facts about drugs, be wise to the real dangers and risks, and make the smart decision not to take drugs.
We need to help young people develop the skills to resist peer pressure to take drugs, in the context of developing healthy lifestyles. It is also important to communicate to young people that there are places to go for advice and help, and in confidence.
My noble friend Lord Mancroft referred to the Home Office drugs prevention initiative. He referred to what he regards as the ineffectiveness of the Home Office drug prevention initiative in view of the fact that drug misuse has increased in the four years since the initiative was introduced. Prevention initiatives, especially educational programmes, are long-term investments. The point was well made by the noble Lord, Lord Russell of Liverpool. All the work supported by the initiative's local teams is monitored and evaluated. The drugs prevention initiative is pulling together the lessons learned to produce good practice guidance for use all over the country. The first route to that programme should be evaluated and circulated next year.
On the subject of legalisation, my noble friend has made his views known on a number of occasions. To destroy the black market in the way he suggests would be to make available all the drugs currently misused—not only cannabis, amphetamines and ecstasy, but heroin, cocaine and crack—on demand, at a price lower than the traffickers' who would assuredly fill the gaps. I cannot agree that that is the right way forward. Think of the health problems that we would have to face, my Lords.
My noble friend also made reference to drug education in schools, much of which I have touched on. However, I welcome the interesting points made by my noble friend Lord Mancroft on how to persuade young people not to misuse drugs. I do not share his pessimism on the prospect of success, but I welcome his confirmation that we should try to change young people's attitudes. We recognise that young people often know more about drugs than their parents or teachers. Simply telling them that they are wrong to take drugs 770 will not work. It is not enough. We have to recognise that young people are knowledgeable and that they like to rebel. Messages in schools and in the wider community must be directed at undermining young people's views that drug misuse is acceptable and not harmful. The fact that drug misuse is harmful and can destroy their health and their prospects is an important message.
My noble friend also referred to the Government taking account of results of an examination of what works in the methadone treatment. As part of the effectiveness review, there will be a major research study looking at the effectiveness of treatment for up to 1,000 clients receiving treatment, including people receiving methadone. The results will be considered by the Department of Health. One of the tasks identified for the Department of Health in year two of the strategy is to ensure that cost-effective and appropriate services are available to drug misusers.
The noble Baroness, Lady Masham, was concerned about crack. She asked what the Government will do about crack. The Department of Health's task force will be commissioning a study to look specifically at what treatment is available for people who use crack cocaine, and what works. Its recommendations on how such services should be provided in future will form part of its report to Ministers.
Much was made of the review of the Customs officers. A number of figures have been bandied around in the course of the debate. Let me assure your Lordships that the outcome of the fundamental expenditure review will not detract from the effectiveness of the Customs' response to drug smuggling. The proposals are designed to enhance and develop existing strategies to provide greater flexibility and better targeting for Customs operations against drug smuggling. The review builds upon successful enforcement techniques established over recent years, notably since the abolition of internal borders with the completion of the single market in 1993. The review recommends enhanced targeting and matching resources to areas of highest risk to maximise the incidence of drug seizures. There will be a continuous Customs presence at locations where the highest risks exist, coupled with the flexible use of mobile anti-smuggling teams. That will provide a swift response across the UK to identify threats as well as providing a highly visible and unpredictable deterrent.
It has been found that Customs objectives could be achieved through a net reduction of 242—the figure is not 800—anti-smuggling posts, out of more than 4,000. However, intelligence activity will be enhanced by the creation of 50 new posts in investigation or intelligence work using posts redeployed from other locations. There will be no Customs-free airports or ports in the UK. There is no evidence to suggest that that flexible, selective and targeted approach has adversely affected the effectiveness of enforcement activity. Indeed, Customs' results prove otherwise. Seizure values increased from £244 million in 1990 to over £500 million in both 1992 and 1993. In 1992, 47 major drug 771 smuggling organisations were dismantled, and 69 in 1993, a rise of 28 per cent. In the current year the figures are looking even better.
There is no question of Customs being left with insufficient anti-smuggling resources to combat illegal importation of drugs, firearms or any other dangerous item or product. There appears to be success in using intelligence rather than relying on ad hoc random inspection of goods on entry into the United Kingdom.
My noble friend Lady Gardner of Parkes was concerned about the insurance industry. The Government understand that all members of the Association of British Insurers have accepted the change in policy, and that the vast majority will introduce the changes to the questionnaire by the end of this year. We very much welcome that. I have no doubt that my noble friend will be vigilant in ensuring that that happens.
With regard to Scottish Provident, we have not seen the wording of each society's form. I am happy to write to my noble friend about the specific case to which she referred.
The noble Lord, Lord McNair, referred to the Narconon programme. The purchase of services for the treatment of drugs misusers is for local and health authorities to decide for themselves based on the assessment of the needs of an individual. Therefore if those authorities can be persuaded that it is effective treatment, it must be a matter for them to consider purchasing into it.
The future of the central drugs co-ordination unit was referred to by the noble Lord, Lord Russell of Liverpool. During the next few months Ministers will be considering proposals for monitoring implementation of the strategy and as regards how a national co-ordination can be ensured. That will include consideration of a continuing role for the central drugs co-ordination unit. The noble Lord made some interesting and constructive suggestions in relation to education programmes. In particular he commented about the importance of training and the training of trainers. I am sure that my right honourable friend the Secretary of State for Education, who indeed is aware of the debate, will note and take account of the references that he made to Ofsted.
The noble Baroness, Lady Mallalieu, made reference to GPs. Many doctors choose to prescribe for their addict patients, often in a shared care arrangement with a specialist agency. That is, frankly, the preferred model of care set out in the clinical guidelines to which the noble Baroness referred. Guidelines give advice to doctors on how to establish appropriate prescribing levels from gradual withdrawal programmes to the longer-term maintenance programmes. The Green Paper recognises that general practitioners have the same responsibility to provide general medical care to drug misusers as to any other patients. The Department of Health will review the arrangements for shared care of drug misusers. It will also consider ways to ensure that an adequate number of general practitioners in each health authority treat drug misusers, and that appropriate 772 training and support is available for those who need it. It is our view that doctors prefer guidance rather than governments interfering in clinical decisions.
Reference was made to the heavy hand of the Home Office drugs inspectorate. It is not a gestapo. Its role is to monitor the prescribing of controlled drugs in order to prevent diversion to the illicit market. It does so in close co-operation with the medical profession. It is not unknown for a doctor to enter into the illicit market. It is also not unknown for a doctor to become embroiled in becoming a misuser or abuser of drugs. It is precisely because of the international research evidence which indicates that there are considerable benefits in providing methadone—I refer again to the methadone point—in structured programmes that the Department of Health is funding up to seven structured methadone maintenance programmes. There will be full evaluation. I believe that that was the final point made by the noble Baroness.
I am grateful to all noble Lords who have contributed to this wide-ranging, interesting and, as I said earlier, sensitive debate. The theme of the debate, which I believe has received unanimous support throughout, is that tackling this vexed issue is most effectively done by tackling it together. I thank the noble Baroness, Lady Masham, because I believe that she was the force behind the proposition for today's debate.
§ Baroness Masham of Ilton
My Lords, before the noble Baroness sits down, perhaps she could give some assurance that sexually transmitted treatment services will remain confidential when GPs have total funding?
§ Baroness Blatch
My Lords, I have just taken a whispered aside from my noble friend who has responsibility for that. I understand that confidentiality will be honoured.
§ On Question, Motion agreed to.