Residential Care Standards

HL Deb 14 January 2001 vol 630 cc940-62

9.36 p.m.

Lord Taverne rose to ask Her Majesty's Government whether they have considered the impact of the proposed residential care standards for younger adults on their national drugs strategy and crime reduction agenda.

The noble Lord said: My Lords, first, I declare an interest. I am chairman of a charity providing treatment for drug addiction and alcohol addicts called ADAPT, which stands for Alcohol and Drug Addiction Prevention and Treatment. We run two large clinics, one at Barley Wood near Bristol, and the Princess of Wales Treatment Centre at Mundesley, in Norfolk. Each has a capacity of over 60 beds. We also provide treatment in prisons.

Perhaps I may begin with some general observations about drugs and crime. As is pointed out in this week's edition of the Economist, more people in Britain use hard drugs than in any other European country. We also have the largest number of people in gaol per head of population, except for Portugal. Those are hardly two records to boast about.

Part of the reason why our gaols are so full is that we impose longer sentences. However, there is clearly a connection between the two records, because at least 50 per cent—most people believe 60 per cent—of crime is drug-related. Certainly, two-thirds of those arrested test positive for drugs.

One way to combat drug-related crime may be—as is argued by an increasing number of senior policemen—to change the law relating to drugs. However, that is a controversial topic and is not the subject of our debate. Probably the most effective way of reducing crime is to cure people of drug addiction. It also saves lives and avoids untold misery for the families of addicts.

Government policy has recently changed for the better. It is now accepted that in principle it is better to treat addicts than to send them to gaol. It is also recognised that residential care is the best form of treatment. Furthermore, some order is being imposed on the chaotic pattern of referral for treatment. At present, there are about 10 different channels for referral, ranging from various local authorities and community health centres to the probation service. At present, where you live decides whether you have access to treatment, and some local authorities do not refer people at all. The new National Treatment Agency should be a vast improvement. I hope the Minister will assure us that in future treatment will be available for all addicts, irrespective of where they live.

Another change is that more effective treatment is provided in prisons, through the rather inelegantly named CARAT scheme—Counselling, Assessment, Referral, Advice and Throughcare services—and also through rehabilitation courses.

Ten days ago I visited Blundeston Prison near Lowestoft. I was much impressed. Treatment seems to be working well. That is not only because of the quality of the professional service, but because of the personal initiatives taken in the prison by the drugs strategy co-ordinator, Mr Tony Goldson, and the strong personal support of the governor, Mr Jerry Knight. Prisoners whom I talked to spoke enthusiastically about the rehabilitation course. The biggest problem is resettlement after release, particularly providing accommodation and employment, but that is another story.

The regulations for residential care standards—or national minimum standards for care homes for younger adults, as they are now officially called—were designed with the best possible motive of improving standards of care generally. However, when I saw the original draft of the regulations which were to apply to those being treated for drug abuse, I was amazed. The work of various drug treatment clinics was about to be made impossible. That is why three of us—the noble Earl, Lord Howe, the noble Lord, Lord Mancroft, and I—went to see the Minister who is replying to the debate and his colleague in the Department of Health, Jacqui Smith.

Let me give a few examples of what the proposals would have meant as they stood. Under the proposed standards, patients were to have their own rooms with bathroom en suite, their own key and a right to lock themselves in. That is a perfect recipe for suicide, which is a common danger among addicts. Patients were to receive their own mail unchecked and to receive visitors of their own choice at any time. That is a perfect recipe for ensuring that they continue to get drugs. They were to be free to opt out of group activities, yet the whole basis of treatment is often group therapy. Further, by severely limiting the size of all establishments, the proposed standards would have ruled out clinics such as ours, which I can sincerely say does a lot of good work, as many of our former patients testify. The costs of complying with the new standards would have driven many clinics out of business. Many other provisions were wholly unsuitable for drug treatment centres.

The basic trouble, as one of my colleagues in the deputation pointed out—I forget who—was that the requirements, which might be well suited to those in long-term residential care, who need privacy and a non-institutional environment, were wholly unsuited to drug addicts on a relatively short-term course of up to six months, who need to be taken out of their own isolation.

Let no one say that Ministers never listen. I am sure that the noble Earl will echo my delight that the proposals have now been amended. As far as I can see, without having had the chance to consult workers in the field on all the details, our main concerns have been met.

On the standards for dealing with individual needs and choices, the new document states: In homes for people who misuse drugs or alcohol, restrictions on decision making may be necessary in the initial stages of a treatment programme". The section on lifestyles states: For people with substance misuse problems, curtailment of lifestyle preferences may be required at the start of the rehabilitation process". Further, patients' control over their own medication is required only where appropriate and the required option of a single room does not apply to homes offering rehabilitation for people who misuse alcohol or drugs.

I am deeply grateful to the Minister and his colleague Jacqui Smith for allowing common sense to prevail. It may be said that that makes my Unstarred Question otiose, but I do not think so. It gives us an opportunity to stress the importance of treatment and of approaching it in the right way.

I shall end with a general observation that is, perhaps, rather more critical. Over several decades, too many Ministers have allowed over-regulation and bureaucracy to become a national disease. We are now probably the most heavily regulated country in the European Union. I shall give various examples of that from various fields.

Recently, the Financial Times reported that exporters in the European Union found that they had to fill out more forms in exporting to Britain than to any other EU country. Teachers complain about the enormous amount of time they have to spend filling out forms. Research workers conducting necessary experiments on animals find that it takes at least twice as long to obtain a licence in Britain as in Germany and five times as long as in the United States; and yet extra bureaucracy can actually worsen the plight of animals.

Even these much improved regulations for the standards of residential care go into minute, often—one suspects—unnecessary detail. Some of them may still be inappropriate for drug users. Managers, for example, have to agree with each service user a written and costed contract. However, when they arrive, most of our patients are in no state to agree or understand anything, let alone to sign a legal contract. They can of course walk out if they want to, and some of them regrettably do; so in that sense they agree to their treatment. The regulations, however, are totally unrealistic in the extent to which they require detailed consents. It is still not clear, for example, whether they still require that we must let patients lie in bed in the morning as long as they want to.

The standards require that, in rooms for four patients, which are now allowed, privacy must be assured by screening or the provision of furniture. That type of detail really does not make much sense. Furthermore, although it no longer applies to drug clinics, is it really necessary to stipulate that communal areas, for meals or for socialising, for example, must be at least 4.1 square metres per service user? Are Ministers sure that it should not be 4.2 or 4.0 square metres?

Is it realistic to insist that there must be staff on duty at all times who can communicate with service users in their first language, including sign; and have skills in other communication methods relevant to service users' needs (eg block alphabet, braille, finger spelling, Makaton, total communication, manual deafblind language, moon, personal symbols"? Regulations cannot cover everything. We should not be dominated, as we are, by the blame culture that tries to cover management against liability for every conceivable mishap. The motive is to cover your own back in case you are sued; or, if one is a Minister, to avoid criticism if something goes wrong. We are going to have to become more robust and defend the need to take some risks. If regulations try to guard against every conceivable risk, they quickly become oppressive and self-defeating.

I therefore hope that the admirable example set by the two Ministers in the Department of Health will set a precedent, and that in future a fresh air of common sense will blow away the cobwebs of over-regulation throughout the whole machinery of Government. Hope springs eternal.

9.48 p.m.

Baroness Massey of Darwen

My Lords, I am very happy that the noble Lord, Lord Taverne, has introduced this non-otiose Question, and done so with such knowledge and concern. It gives us the opportunity to debate the important issue of the treatment of drug misuse. I must declare an interest as I have recently become the chair of the National Treatment Agency for Substance Misuse, whose brief is to raise standards and increase the consistency of drug treatment. I shall say more about standards and consistency later. I shall first briefly discuss the larger picture of problematic drug misuse, and then move on to residential care.

We are currently discussing crime reduction. However, although it may be obvious, it needs to be restated that crime is not the only problem. As the noble Lord, Lord Taverne said, drug abuse can devastate the health of individuals and be destructive of relationships and of families. So, for many reasons, we have to get interventions to treat drug misuse as right as possible.

Treatment and, within that, residential care are of course only one strand of the national strategy; the other strands also are key. They include a focus on helping young people to resist drug misuse, protecting communities, and stifling the availability of drugs. We know that treatment works and that there are major ways of treating problematic drug misuse: out-patient prescribing interventions and counselling interventions as well as residential rehabilitation. The effectiveness of all has been studied and residential rehabilitation seems to be effective, depending, of course, on the problems and motivations of the individual being treated and on the quality of the intervention.

The national treatment outcome research study has estimated that for every pound spent on treatment, £3 are saved to the criminal justice system. However, for treatment to be more effective, we need better consistency of practice among the current 600 treatment providers. We need to get people into treatment faster. We need research on both prevention and treatment. We need better data on drug related attendance at casualty departments and on numbers in residential treatment. Here there seems to be some inconsistency between Department of Health figures and those of addiction agencies. That seems to involve which beds you count; for example, whether or not we include those provided in mainstream sectors such as units for the homeless and probation hostels. Whatever the problem as regards counting the number of people in residential treatment is, I suggest that accurate baselines of who is being treated where, how and for what are needed to inform practice.

One target of the national drug strategy is to double the number of drug users entering treatment by 2008. The number of problematic drug misusers in this country is estimated to be between 100,000 and 200,000, many of whom do not seek, or cannot get, access to effective services.

Let me address the issue of residential care from some basic principles. We know that people who get into difficulties with drugs comprise a diverse population. Many have relatively minor problems. What requires treatment is the range of acute and chronic problems. Drug dependence is the main condition requiring treatment. Dependence is, as we know, a psychiatric disorder made up of psychological, behavioural and physiological symptoms such as continued use and problems with withdrawal. Many patients entering treatment have high levels of psychological health problems; 50 per cent have committed some form of crime in the three months prior to intake.

The tasks for rehabilitation centres are thus complex and difficult. Added to those problems, early drop-out from residential rehabilitation appears, not surprisingly, to limit the effectiveness of treatment. Some 25 per cent of those being treated leave within two weeks and 40 per cent by three months. The thrust of the Question of the noble Lord, Lord Taverne, is related to the draft standards for young adults published by the Department of Health last year. He went into that in some detail. I understand that about 90 per cent of those standards were considered appropriate by drug and alcohol specialists—DrugScope and the European Association for the Treatment of Addiction are to be congratulated on their tenacity and concern—but that those relating to the physical environment (for example, multi-occupancy rooms) could close some units. Clearly, that would have had a disastrous impact on the individuals concerned and on the likelihood of more crimes being committed. The national treatment agency was, and is, concerned to raise quality without reducing capacity.

As the noble Lord, Lord Taverne, said, the Department of Health listened and agreed that the standards be modified. The national treatment agency expert residential group met last week and the sense was that the group had been almost too successful in its lobby and that the standards now set a relatively low baseline. That needs addressing and I shall comment on it further in a minute.

It seems likely that providers will be challenged to meet the human resource standards; that is, to have all managers and 50 per cent of staff holding relevant NVQs by 2004, with the rest of the staff working towards them. That may be particularly difficult for some of the smaller units not linked to umbrella organisations. In addition, the rehabilitation units are not well linked to the regional social care training development networks and resources. They need to be encouraged to be so.

The agency is also concerned that commissioners have difficulty investing in rehabilitation due to the spot purchasing agreements; the fact that the cost of placements is likely to rise as staff become better qualified and quality rises; and the fact that commissioners may need to invest in regional groupings, such as that set up by the Greater London Purchasing Group.

There is also concern that, in the longer term, units may face difficulties as the cost of all residential care rises and local community care funding potentially does not. As there is a statutory requirement to provide care for other groups—for example, the growing number of elderly—local authorities seem likely to spend less on preventing drug and alcohol misuse because there is no statutory requirement to provide placements in those circumstances.

The agency was created last year and its strategy recognises the challenges. I believe that the noble Lord, Lord Taverne, will agree that having the agency in place should address a multitude of issues relating to reducing crime and improving the health of those individuals who are addicted to misusing substances. Importantly, the agency has a regional structure, and it will be able to address, with other regional bodies such as community drug teams and drug action teams, those issues at the micro-level which is where national strategy must focus if it is to work.

The Department of Health "models of care" project points out that to achieve an effective care system, screening, assessment, care co-ordination and treatment review need to be in place. There must be collaboration between all health and social care organisations.

The agency will commission work on the impact of the standards and, working with the new Care Standards Commission, a project to address the issue of human resource standards to ensure that inspection units have staff who are competent in substance misuse and that guidance is developed. Implementation projects could address the issue of standards and build on Department of Health standards. Once those have been achieved, it should set benchmarks that are higher.

There is clearly much work to do. How does the Minister think that quality standards, training of personnel and inspection and co-ordination of the organisation of residential treatment for drug misusers contribute to successful treatment and its impact on individuals and communities?

9.57 p.m.

Baroness Masham of Ilton

My Lords, I am grateful to the noble Lord, Lord Taverne, for bringing this matter to the attention of noble Lords. Having just spoken in the previous debate, I assure noble Lords that I should not speak again unless I felt that this was a very important matter.

For some years I chaired Phoenix House, which is an organisation that has several residential drug and alcohol rehabilitation houses in various parts of the country. I have also attended two funerals of young people who died from drug and alcohol addiction. One of them was a god-daughter who had been to Oxford University. Those lost young lives arc such a waste and such a tragedy to families and friends.

I have served on the All-Party Parliamentary Drugs Misuse Group for many years—since its inception. Governments for years have tried to stem that growing scourge which causes so many problems throughout the world. Drug and alcohol addiction take over the lives of many people. They lose the ability to control their own lives and their lifestyle becomes chaotic and unreliable. They often turn to crime or prostitution to feed their habit.

When addicts see sense and want to go into treatment, it is important that there are rehabilitation places to help them to kick the habit. If there are not enough beds and they have to wait, the urge to seek help may pass and the opportunity may be lost. That can mean a matter of life or death.

I am sure that most people will welcome the national minimum standards for care homes for younger adults in long-term residential care. However, for the rehabilitation of drug and alcohol addicts, the needs can be different. It would have been excessive to have en suite bathrooms to every bedroom. Could it not encourage the smuggling into bedrooms of drugs and alcohol if the resident addict was able to lock his door from the inside and have locked cupboards?

Much of the treatment is carried out in group sessions and people in treatment support each other. Addiction can mean devious behaviour, and service users with such problems need a regime of coming to terms with a condition that they must watch for the rest of their lives. It can be a hard struggle, and many treatment centres work following the 12-step programme. It is a progress ladder.

At a presentation by the director of Clouds drug and alcohol rehabilitation unit, the members of the All-Party Parliamentary Drugs Misuse Group were told that if all the requirements had to be put in place, they would have to cut the number of their beds by 50 per cent. If that was the case with all the centres throughout England and Wales, many desperately at-risk addicts would miss out on rehabilitation and could well be sent to prison as an alternative.

I hope that the Government will be able to take a flexible view of the different situations and of the priority needs of the different groups. Drug and alcohol addiction rehabilitation requires a high percentage of trained staff to deal with the many side-effects of coming off drugs, such as suicide risks and depression. Much time is also spent on anger management and counselling. The treatments are expensive.

I am delighted to hear that the Government have listened, but I hope that tonight the Minister will give us an up-date on what the new standards will be. Are there enough places for young addicts with problems? They seem to be getting younger and younger and some are of school age. I shall be interested to hear the answer that the Minister gives tonight.

10.2 p.m.

Lord Dholakia

My Lords, I support the cogent arguments put forward by my noble friend Lord Taverne on the need to ensure that the proposed residential care standards for young adults impact positively on the reduction of drug misuse and criminal activities by young people. For that reason, I thank my noble friend for introducing this debate.

I have sat as a magistrate for more than 17 years. I have also been a member of a board of visitors for that amount of time, and I have chaired NACRO. Resettlement is at the heart and centre of what we do. It is that background that makes me believe and understand that, unless there is clarity in relation to sentencing, which includes a treatment and rehabilitation model, many of our efforts to divert young people from offending will be futile.

The purpose of residential care standards is to improve the behaviour of young people from what is normally a very low starting point in their lives. The task expected of carers is very demanding and often least appreciated. In many cases, those who are part of the care culture come from backgrounds which carers find hard to handle and change. Young offenders fall into that category. The inadequacies of resettlement arrangements are particularly marked in relation to young people. Most are short-term prisoners. Short-term offenders receive no post-release supervision and much is left to the carers. It is at that point that they could impact on the lives of young offenders.

The evidence documenting the powerful links between drug misuse and crime is now overwhelming. Persistent heroin users typically spend around £10,000 per year on drugs while crack addicts spend on average more than £20,000, much of which is raised by criminal activity. That is more than someone on a minimum legal wage could earn in a whole year, and that must be multiplied by the number of users.

There are many issues which are directly related to drugs. The increasing availability and use of illegal drugs, along with large-scale alcohol abuse, contributes to crime in our society. If we look at any part of our criminal justice system we will find example after example of links between illegal drug abuse and crime to pay for those drugs. That is as clear as the link between alcohol abuse and the level of violent crime.

The number of people convicted of or cautioned for drug offences has more than quadrupled over the past 10 years. Offenders feeding their drug habit now commit around one half of all thefts and burglaries together with a growing amount of crack-related violence and a high proportion of prostitution. The estimated cost of drug-driven crime is now between £3 billion to £4 billion annually. That includes £2 billion to £2.5 billion in losses to victims; £600 million spent on drug services and over £500 million in costs to the criminal justice system.

That is a frightening figure, but it does not feature in the equation when we talk about drug problems. Yet many arrested drug users are at a crisis point, which can be a powerful motivating factor to accept help. That was powerfully demonstrated by a recent study of 80 offenders seen by arrest referral schemes, which arrange treatment for arrested drug users. Six months later, 21 were drug free, 35 were no longer using hard drugs and most of the others had reduced their drug use. The number of crimes committed by the group had fallen to one-fifth of the number they committed in the month before arrest. That is a positive example of the success of the referral scheme.

The effectiveness of drug misuse treatment has been underscored by the Department of Health-funded National Treatment Outcome Research Study (NTORS), which has followed 1,100 people who entered drug treatment programmes in 1995. As the noble Baroness, Lady Massey, pointed out, the NTORS study showed that treatment saves money as well as lives. For every £1 spent on drug misuse treatment, more than £3 was saved as a result of the reduced costs of crime. Moreover, that was just the money saved in the first year after beginning treatment. The long-term savings will be even greater. That is a strong argument in favour of a treatment model, which needs to be developed even further.

There is also encouraging evidence that well-structured drugs prevention programmes can be highly effective. A follow-up study of Project Charlie, a prevention programme used with Hackney primary school children, found that at the age of 14 they had more negative attitudes to drugs than other children, were less likely to have used illegal drugs or tobacco and were better able to resist peer pressure to use drugs.

There is a desperate need for the treatment of drug-dependent offenders and a need for a substantial reallocation of resources to provide for more treatment facilities. Bearing in mind the findings of recent studies, it is clearly identified that the number of offences committed by addicts reduced by one-fifth when proper treatment was available. Treatment programmes are best carried out in the community. However, when drug-dependent offenders go to prison, it is vital that they have access to treatment in prison and effective resettlement on release.

Although the number of treatment programmes in prisons has increased in recent years, there is still a long way to go before we can be satisfied that prisoners with drug problems receive the help that they need. That is frightening, especially for young offenders leaving custodial institutions. That is where those in care, particularly residential care, can receive considerable benefits if the issue is tackled with imagination and skill.

Yet until recently only one-third of the Government's spending on combating drugs was on treatment, prevention and education. The other two-thirds was devoted to enforcing the drug laws. Since then, however, the Government have adopted a strategy to tackle drug misuse, which is backed up by extra resources for new treatment and support services for drug misusers, including measures to combat drugs in prison—mainly by treatment programmes—drug treatment and testing orders for the courts, education and prevention programmes and arrest referral schemes.

Past approaches to tackling illegal drugs, which have devoted the lion's share of resources to enforcement and wholly inadequate funding to treatment and prevention, have failed. Success in reducing drug-driven crime depends on continuing moves towards a more rational response in which prevention and treatment receive much greater priority than they have in the past. Residential care can play a key part in providing the stability and support, which can enable young people to persist with treatment to overcome their drug habits. It is vital that the proposed care standards enable that to happen. We should ensure that care standards put emphasis on a balanced, proportionate and effective response to the harms done by illegal drugs. It will do far more to reduce drug misuse than punitive approaches, which increasingly lack credibility with law enforcers, the general public and the drug addicts whom we are all trying to reform.

10.11 p.m.

Lord Broolke of Alverthorpe

My Lords, I express my grateful thanks to the noble Lord, Lord Taverne, for initiating this short debate. My contribution will be very short indeed. The debate gives me the opportunity to speak as one of the patrons of the European Association for the Treatment of Addiction (UK). I am happy to see the noble Lord, Lord Mancroft, who is similarly a patron. I express gratitude on behalf of the association to Ministers and officials for the way in which they have not only listened to the representations made by the association and others, but have acted on all the major points which have been put to them.

It is a pleasure—having listened to criticism of the Government in this Chamber for two days solidly last week and then for most of today's debate—to be able to say that in some very important areas the Government are listening closely and taking up the points which are being put to them.

Had the Government proceeded with the original well-intentioned proposals which they put out for consultation on core standards for residential homes, certain aspects would have had—as has been mentioned—a detrimental effect on the number of young adults gaining access to residential treatment for drug and alcohol problems. Happily, there has been a positive response. All the major changes, certainly those that my association were advocating to the original, were accepted by the Government. Again, I say many thanks.

While on my feet I want to take the opportunity to congratulate my noble friend Lady Massey of Darwen on her appointment as chair of the National Treatment Agency. I am sure that she will do an outstanding job. I am certain that the House would want to join me in wishing her well. There is much to be done, as my noble friend acknowledged earlier, not only in providing coherence and consistency—to pick up the point of the noble Lord, Lord Taverne—out of the chaos which, to a degree, seems to be emanating in the treatment of drugs following the establishment of the NTA.

There is much work also to be done, as the Minister knows—I raise the matter frequently with him—on the subject of alcohol. In many respects, we have even more criminality and even more people needing treatment in that field, notwithstanding the great difficulties we have with drugs.

I conclude with a sting in the tail, after all the "thank-yous" to the Minister, to press my points. When can we expect the Government to make similar provision on alcohol to that of the NTA and drugs? When can we expect to see whether the NTA's remit is to be extended to cover alcohol, so that we can start to achieve a more coherent and consistent approach to treatment on that front as well? I thank the Minister and officials for the work done in this area. We look forward to even more listening and action in future.

10.15 p.m.

Lord Mancroft

My Lords, I should like to have spoken on the important Unstarred Question of the noble Lord, Lord Taverne, at slightly greater length, but unfortunately I returned to the House only today so must content myself with the gap, for which I am sure that your Lordships will be extremely grateful.

I should start by declaring my interest as chairman of the Drug and Alcohol Foundation, of the Addiction Recovery Foundation, of the Mentor Foundation and one or two others. I have been involved in the field for some time and in debates about standards for many years. Had those standards arrived on the book, as it were, in their original form, it would have been completely disastrous for this small, underfunded and incredibly fragile sector.

We should see if there are lessons to be learnt: why did we go down that route and what could we learn for the future? First, we probably got on that track because officials who were drafting the proposals, with the best will in the world, did not understand the difference between short-term residential rehabilitation and the needs of caring for the elderly and disabled young people who are in facilities for much longer. It must be said that most politicians do not understand the differences and requirements of that incredibly important but tiny sector.

The second reason is that the consultation process on the standards was not carried out correctly. I do not mean that anyone was cheating, but it is another example in which officials did not really know who to consult and how to consult them. That is partly their fault but partly ours: it means that we are not talking to government properly; equally, it means that government are not talking to us properly. The line of communication is clearly wrong and we must do something about that.

I find it slightly ironic that the department should be talking to us about standards. My experience is that the quality of care in most voluntary care facilities in this country is infinitely higher than ever it has been in the state sector. The state sector holds us back. I should like the state sector to get out of drug treatment altogether. It is expensive and not well provided for.

We have learned from the process and the standards that we have now arrived at that the system works. We have ended up with the right standards at the end of the day. That is good, but it is a pretty tortuous route down which to go. The Government will deny this, but I do not mind criticising them for it because I criticised my own party when in government much harder and will continue to criticise any government until they get it right, but drug treatment is the forgotten sector. Politicians and government do not like it. It is forgotten and tiny. I have been involved in drug treatment for 15 years now, and the sector has grown by a maximum of 10 or 15 per cent—perhaps a little more, but it is tiny. It has certainly not grown at the rate that the problem has.

That may change with the new National Treatment Agency. I am sure that it will. I congratulate the noble Baroness, Lady Massey of Darwen, on taking on the chair of that incredibly important organisation for which we in the sector—those of us who are providers—have great hopes. We look forward to working with it. I listened carefully to what the noble Baroness said and will read it again in Hansard tomorrow with great care. The only solution to the drug problem is healthcare. Drugs are a health problem, and we cannot cure health problems using the criminal justice system. We must use healthcare. After reading today's and yesterday's papers, I never again want to hear anyone claim that drug use is a consequence of social deprivation. Anyone who thinks that should read today's newspapers.

I suspect that the Question tabled by the noble Lord, Lord Taverne, is a hangover from before Christmas, when we were more concerned than we are today. We are happier now. We are immensely grateful to the Government for having taken on board our concerns. It was worth all the hard work. The standards will be immensely helpful, as will anything that improves standards.

It is clear to me that it is to the Minister that our gratitude should be directed. I am certain that it was his intervention in the issue, when he recognised that something had gone awry, that helped to put things right. That is when the problem was solved. It is rare to find a Minister who is prepared to go out on a limb like that, and the House and everyone in the sector are grateful to the noble Lord, Lord Hunt of Kings Heath, for doing so.

10.20 p.m.

The Earl of Listowel

My Lords, I am grateful for the opportunity to speak in the gap. What the previous speaker said about the Minister rings absolutely true to me, although I do not know the details of the matter.

I shall draw the House's attention to a conversation that I had this afternoon with Professor Sonia Jackson, who has spent many years studying the education of children in care. She drew my attention to the pedagogy system used on the Continent. Children who are troubled are looked after by pedagogues who have a degree-level qualification in their area of expertise and one or two years of specialist training. In this country, 80 per cent of our residential care workers are without any educational qualification whatsoever. The Government are making inroads into that situation, and I appreciate that. I hope that that will continue.

10.22 p.m.

Baroness Walmsley

My Lords, I thank my noble friend Lord Taverne for introducing the debate. There is a great deal of support in all parts of the House for much of what the Government are doing, and they are to be congratulated on that.

Important caveats have, however, been raised. The Government are right to move towards treating drug addicts as patients who need help, rather than criminals who need punishment. Other crimes committed in order to support a drug habit may require some sort of sanction, but it is unreasonable and ineffective to criminalise the addiction itself. When a drug-dependent person is an involuntary guest of Her Majesty, it is often a good time to interest him or her in the idea that a drug habit can be conquered. That is why my noble friend Lord Dholakia is right to say that it is important to have good drug treatment centres in prisons.

It may seem contradictory, but the two key words in the debate are "flexibility", to which the noble Baroness, Lady Masham of Ilton, referred, and "consistency", to which the noble Baroness, Lady Massey of Darwen, referred. While urging the Government to operate to the highest possible standards in its care for people with a drug dependency, noble Lords have stressed the importance of being responsive to the needs of the people concerned. The system must have built-in flexibility. The size of rooms and sensible lifestyle rules are important, but much more important are the human beings with whom people in drug clinics interact. They need their knowledge, experience and commitment and the interaction of the clinics with other relevant agencies.

We must have the same standard of care for all our citizens who need it. It must be equally accessible in all parts of the country. Currently, it is not, and that is one of the problems with the system. As my noble friend said, there are multiple routes to referral. Some are through local authorities or health authorities, who have little or no budget for drug treatment, which means that it depends on where a drug addict lives whether he or she will get the necessary help. What do the Government propose to do to tackle the problem of so-called postcode drug treatment?

I recently chaired a policy working party of my political party reviewing our policies on drugs. In the course of that work we heard from many experts across the whole spectrum of opinion. However, two issues clearly came out of our evidence sessions. First, none of the statistics is reliable. No one really knows how bad the problems of addiction to serious drugs is in this country, except that it is much worse than it is in most other European countries.

The prohibitionist strategy pursued over the past 30 years since the Misuse of Drugs Act 1971 cannot be shown to have enjoyed much success in terms of reducing the supplies or use of illegal drugs. Indeed, one of the most disturbing aspects of existing policy in this field is that there has never been any rigorous official assessment of its effectiveness. After such a long period, it inevitably gives rise to the suspicion that the policy is driven by dogma and/or inertia rather than an intellectually or politically honest appraisal of the issues. The need for more research work is obvious.

According to both the Economist and the European Monitoring Centre for Drugs and Drug Abuse, the UK has some of the highest levels of drug use and misuse in Europe. The number of hard-drug addicts has increased from about 1,000 30 years ago to 270,000. Who knows if the figures are to be believed? The problem has grown enormously but the resources have not grown to match, as mentioned by the noble Lord, Lord Mancroft.

However, changes of scale are probably true. For example, from 1995 to 1999 the number of deaths attributed to heroin or morphine use in England and Wales rose by 110 per cent. That is just over a four-year period. There is also information about trends. The noble Baroness, Lady Masham, is right; drug abusers are getting younger. The average age of heroin users is declining in the UK—it is currently 26 years—while it is rising in other European countries such as the Netherlands where it is 39 years. The authorities there are talking about opening up drug rehabilitation centres for the elderly very soon. The greatest increase in hard-drug use in recent years in the UK is among the under-21s.

The amount of crime associated with drug use is mind-boggling and has been referred to by a number of noble Lords. It is estimated that in 1998 alone drug-related property crime accounted for stolen goods of more than £2 billion in value.

The picture is of a situation completely out of control. It is clear therefore that if we can reduce addiction we can reduce crime. Clearly it is vital to get the approach to drug treatment right and more treatment services need to be available.

The second issue which emerged from our evidence-taking from representatives of the drug charities to whom we listened was the fact that drug treatment works only when the addict wants it to and that one needs to treat the whole person, not just the addiction—preferably in a residential and mutually supportive environment such as those described by my noble friend Lord Taverne and affected by the care standards.

Serious drug dependency is usually a symptom of a life that is lacking in something. It fills a gap. In fact, it fills a person's whole life from when he gets up and goes to find the wherewithal to get his first fix to when he seeks the refuge of sleep. Drug addicts are not lazy, disorganised people. It needs a lot of effort and organisation to feed a habit. The addict's whole life is often dedicated to it.

So-called "problem" drug users—that is, those who are addicted to hard drugs who are at most risk of damaging their health and who are most likely to become involved in crime—generally experience a range of social and personal problems, but not always. They include, for example, unemployment, poor housing and dysfunctional family relationships. Programmes to help such people break out of their drug dependence have to tackle all those problems holistically. Even if a user comes off a drug for a time, if the underlying problems he faces in his life, and above all the pervasive sense of hopelessness and having nothing positive to live for, are not tackled, he is likely to fall back into drug abuse.

If therefore one just takes away the drugs, one has to fill the life with something better. That is why the quality of staff at treatment centres is even more important than the quality of the facilities. It is vital that bureaucracy and dedication to detail does not get in the way of creativity and experimentation with ways of putting together programmes and support systems based on best practice and knowledge of what works.

One of the areas in which the Government's drugs policy is failing is that of drugs education. Not every young person has the opportunity afforded to one high-profile young experimenter highlighted in yesterday's Sunday papers of seeing for himself what drug abuse can lead to. Many young people do not listen to much drug education because they can see that the law is inconsistent and illogical. As the noble Lord, Lord Brooke, pointed out, dangerous drugs like alcohol and tobacco are legal and cannabis is not. But that is a debate for another time.

Another of the ways in which the system fails at present is the lack of facilities to prescribe, supply and administer drugs safely under the control of medically qualified people. The majority of deaths of hard-drug users, apart from those which result from needles that carry infection, result from overdoses caused by the variable quality of contaminated drugs. Yet a very small number of GPs are licensed to prescribe heroin. Heroin can be very useful as an alternative to methadone for maintaining an addict while other aspects of their problems are tackled. Can the Minister tell us whether there are any plans to extend the small pilot schemes for heroin treatment centres which I gather are already under way in some parts of the country? Will he also tell us what results have emerged at this early stage about the effectiveness of drug testing and treatment orders?

Finally, perhaps I may join with my noble friend Lord Dholakia in urging the Minister to think long term. As with bed blocking in the NHS, a patient costing the NHS £1,000 a week could be looked after in a care home for £400 if beds were available. Penny pinching on drug treatment services is short-term wisdom but long-term folly. The human cost to the lives of addicts and their families and the cost in peace of mind to those who are burgled and mugged to support someone's habit and the financial cost to the country of policing and health services vastly outweigh the cost of a concerted drug education and treatment programme. From these Benches, we say this to the Government. Keep up the good work. But we need to see even more courageous and visionary policies and the resources to implement them.

10.32 p.m.

Earl Howe

My Lords, the noble Lord, Lord Taverne, demonstrated how well qualified he is to bring this important Question to the Floor of the House. He spoke with a great deal of wisdom and authority. I have no doubt that the Minister will wish to pay close attention to all that he said. The same applies to no less an extent to the speeches of other noble Lords, not least of my noble friend Lord Mancroft. His commitment to the cause of drug prevention, education and the treatment of drugs misuse has been unstinting over many years. It is with considerable relief, therefore, that we anticipate that the Minister's answer to the Question on the Order Paper will be "yes".

While the Minister is to be thanked unreservedly for and congratulated on listening to representations made to him on this issue, many noble Lords are worried that in seeking to lay down care standards largely designed for long-term residential establishments the fundamentally different requirements of drug and alcohol treatment centres would be overlooked. The truth is that in the standards as drafted last year those requirements were overlooked. Had the draft proposals not been challenged from a number of quarters in forthright terms, it is probable that the Government's wider, over-arching drugs strategy might have been seriously derailed. What that says about joined-up government does not bear close scrutiny. What it says about the initial consultation process, as my noble friend Lord Mancroft pointed out, is equally concerning. I agree with my noble friend that the objections to the draft standards that were voiced by drug and alcohol treatment organisations across the country were not some form of spurious special pleading founded on worries about the financial viability of the sector. They were root and branch objections about the catastrophic effect that the proposed standards would have on the Government's fight against illegal drug use and all that goes with it. To illustrate that, I should like to say a little about the strategy itself.

Since they were first elected, the Government have quite rightly devoted a great deal of time and effort to the problems of illicit drug use. The 10-year drugs strategy, published in April 1998, and the national plan that followed it, focused on several key areas: stifling the supply of drugs; reducing the prevalence of drug taking; and protecting communities from drug-related antisocial behaviour. But the strategy also laid emphasis on enabling people with drug problems to overcome them. One of the main planks for achieving that was a system of well-directed support services, including supervised treatment for addicts.

The target the Government set for themselves was both ambitious and laudable; namely, to increase the number of drug misusers in treatment by two-thirds over the four years to 2005. The rising prevalence of drug misuse over the past 20 to 30 years is worrying not only for the deaths and ill-health to which drug taking leads—bad as those are—but, as has been pointed out by many speakers, also for the devastating social consequences. There is no doubt whatever of the link between drug taking and crime.

Research carried out at the NHS Scottish Centre for Infection and Environmental Health estimated that those who inject drugs, primarily heroin, need £324 a week to buy their supplies. Four out of five people questioned in the survey said that they had committed crimes during the previous six months. Half of the addicts said that nearly all their drug spending money was illegally obtained. The overall average sum acquired through crime each year was £11,000 per individual. The noble Lord, Lord Dholakia, quoted even higher figures than that.

Drug treatment must be a key ingredient in the fight against illegal drug use. Drug treatment and testing orders, introduced under the Crime and Disorder Act 1998, require the offender, if he consents, to undergo treatment for his drug problems as part of his community sentence. The 2001 annual report by the anti-drugs co-ordinator stated that DTTOs had had a significant effect in reducing illegal drug consumption and related offending. Rehabilitation has been shown to work, as was rightly pointed out by the noble Baroness, Lady Massey of Darwen—I should like to add my congratulations on her recent appointment. The national treatment outcome research study showed around a 70 per cent reduction in the number of specific offences among those willing to be treated.

No wonder that the Government's drug strategy set itself such an ambitious target for increasing the numbers of drug misusers receiving treatment. But the strange thing about the Government's drugs strategy, which started on such an extremely promising footing, is the mixed messages from Ministers that periodically cut across it. The draft residential standards are but one example. Another example is the apparent abandonment of specific targets relating to the use of heroin and cocaine by young people. That target has now been replaced by a much more general one which no longer speaks of percentage reductions or specific drugs. It refers merely to reducing Class A drug use among under 25 year-olds. Last October, the Daily Mail reported that Ministers are quietly planning to ditch even that amended target. If that is true, I should be grateful if the Minister could confirm it and say what is likely to replace it.

It is a sad fact, from the statistics most recently published, that the use of Class A drugs by young people, especially cocaine and heroin, shows no signs of decreasing. The consumption of cocaine among the young has risen fivefold since 1998. The most that can be said is that, as some young people take up cocaine, they may he turning away from drugs such as ecstasy, LSD and amphetamines. Against that background, how strange it was last autumn to find Ministers proposing the reclassification of cannabis under the terms of the Misuse of Drugs Act 1971 from Class B to Class C.

The Home Secretary justified that proposal, in part, by saying that it would make sense to those responsible for policing the system and those providing education and advice to prevent young people falling into addiction. The aim of having a sensible and effective policy to reduce drug dependency is laudable. The trouble is that the Home Secretary has not produced any evidence to back up his statement that a change of policy will achieve a reduction in dependency. I am not saying that he is necessarily misguided, but where is the evidence? There is a distinct impression of policy being made on the hoof.

I say that because only the day before the Home Secretary made this announcement in October, the Home Office Minister, Mr Bob Ainsworth, answered a question from the Select Committee in another place about the reclassification of cannabis, to the effect that the present UK policy was not so different from those of other European countries. Bizarrely, the Government proceeded to change their policy even before the Select Committee had reported.

The danger in reclassifying cannabis is that it sends out a message of tolerance—that somehow smoking cannabis is not so very bad. In America, it has been found that when young people think that drugs are harmless, as they increasingly do, drug use increases dramatically. Already in the UK the prevalence of cannabis use is the second highest in the EU, and it is rising.

It is perfectly true that many cannabis users do not go on to use harder drugs, but a number of studies have found links between cannabis taking and heroin. One reason for that is that using cannabis puts young people into contact with those who are users and sellers of drugs, increasing the risk that they will be exposed to, and urged to try, more drugs. The drug czar, Keith Hellawell, has stated in terms that cannabis is a gateway drug. That is why he has been quoted as saying, when a more gentle line on cannabis has been hinted at by the Home Office, that, One of the problems I have is that people and parents who worry are not sure what the strategy is". That is the trouble that the Government tend to get into when they set out a co-ordinated long-term strategy and then deviate from it. All the more reason, therefore, why the welcome, last minute retreat on residential care standards should be carried forward into sensible implementation at local level and adhered to over the long term.

I hope that there will be appropriate guidance and training for inspectors and providers. The need for residential treatment centres is greater now than it has ever been. But the Minister must remember, as my noble friends rightly said, that this is a small sector and its budgets rest constantly on a knife edge. I look forward to the Minister telling us that he understands the need to maintain the confidence of that sector, and, indeed, to see its capacity increase, by sending out clear and consistent messages from all quarters of government.

10.43 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, I thank the noble Lord, Lord Taverne, for raising this important subject and for instituting an interesting debate. I acknowledge his contribution, and the contributions of the noble Lord, Lord Mancroft, and the noble Earl, Lord Howe, in coming to meet my colleague, the right honourable Mrs Jacqui Smith, and I to discuss the issue of the care home regulations and national minimum standards. I can testify to their eloquence and strength of argument. I hope, as they have said, that they feel the Government listened to the points they put across.

The debate has ranged rather wider than matters relating to the Registered Homes Act, and rightly so. I have taken the points made by the noble Lords, Lord Taverne and Lord Dholakia, when they pointed out the relationship between drugs and crime, and their acknowledgement that government policy has sought to address those issues.

A number of important matters have been raised. I should say to the noble Baroness, Lady Walmsley, that I agree that it is important to ensure that there is a co-ordination of treatment referral. I agree with the noble Lord, Lord Taverne, who said that we need a consistent approach across the country. I believe that the drugs strategy to which a number of noble Lords referred offers a way forward in relation to consistency of approach and effectiveness of action.

We can point to a number of achievements thus far. For example, the noble Baroness, Lady Walmsley, referred to the issue of education. The figures show that 93 per cent of secondary schools and 75 per cent of primary schools now have drug education policies in place. That is a substantial increase over the past two to three years, although I accept that we can never be complacent about the role of schools in ensuring that an effective drug education policy is in place.

I was also most interested in the comments made by the noble Lord, Lord Dholakia, about the arrest referral schemes. We are now on track to have schemes that will cover all custody suites in all police forces in England and Wales. I was encouraged by the noble Lord's remarks about the impact that they are having by encouraging problem drug users who are arrested to take up appropriate treatment or other effective programmes of help. It is worth pointing out that there has been a steady increase in drug misusers attending treatment services over the past few years. As far as concerns the national roll-out of drug treatment and testing orders, I can tell the noble Baroness, Lady Walmsley, that we are committed in this respect following successful completion of the three pilot schemes in Liverpool, Croydon and Gloucestershire.

I turn now to the targets in relation to the drug strategy. I should point out to the noble Earl, Lord Howe, that there is a Home Office/Department of Health review in that respect, which is specifically looking at the feasibility of measurement. As regards the point he made about a change in target, I can tell noble Lords that one of the problems is centred around the exact measurement that is used. The issue at hand is that we do not have a baseline against which to measure the target improvements. However, as I said, the matter is now under review.

The noble Lord, Lord Taverne, referred specifically to drug treatment services in prisons. Again, I was very glad to hear his positive comments. Despite the many challenges, it is worth acknowledging that we are starting to see improvements, and not just in relation to drug treatment services. We know that over 23,000 prisoners are currently embraced within intensive treatment programmes supported by voluntary drug testing units. That is assisting prisoners to tackle their drug problems away from an environment that may pressurise them to take drugs. Efforts made in relation to drug treatment services are consistent with a general improvement in health standards and in healthcare within prisons. I also acknowledge the work of the Joint Task Force, incorporating the Home Office and my department, which will ensure that that happens. There is a long way to go, but I believe that the development of health improvement programmes for prison healthcare services in partnership with local NHS services is an important step forward.

Noble Lords have congratulated my noble friend Lady Massey on her appointment as chair of the national treatment agency. This has great potential for the future as regards dealing with some of the issues that have been raised, especially as regards the quality of treatment services, the need for consistency, tackling some of the issues around waiting times for those who require treatment services, and the workforce issues to which a number of noble Lords referred. There is no doubt that there is a significant shortage of professionals available to work in this sector. I agree with the noble Baroness, Lady Walmsley, and the noble Lord, Lord Dholakia, that the task expected of staff working in those circumstances is considerable—all the more so when one considers the lack of available trained professionals.

The Government are anxious to improve the situation. Additional funding has been made available for an ambitious programme of work increasing the number of practitioners dealing with drug misusers. Importantly, by March 2002 the national treatment agency will determine and launch its workforce strategy to encourage professionals to work in the crucial field of drug treatment. Once those standards have been agreed, they will be supported through a programme of training for which the NTA will assume lead responsibility on the appointment of a workforce planning manager.

The NTA will also work with other professional bodies to ensure that substance misuse issues are adequately covered in the basic training and professional development of related professional groups such as doctors, nurses, social workers and probation officers.

Understandably, part of our focus in this debate is on residential treatment centres. They are but one of a range of services to meet the needs of drug misusers as they try to overcome their dependence. However, as my noble friend Lady Massey pointed out, the national treatment outcome research study demonstrated not just the value of a number of treatments in general but specifically the value of residential treatment in reducing drug use and the consequential benefits of improved mental and physical health for the client and reductions in criminal behaviour. I wish to make it absolutely clear that the Government believe that residential treatment has an important role to play. It is one which we believe will be enhanced, rather than diminished, by the introduction of national minimum standards.

The noble Baroness, Lady Masham, asked specifically about the number of rehabilitation places available within residential care. My understanding is that there are approximately 3,100 residential rehabilitation places within the current drug treatment services. Of course, there will always be a debate about whether there are sufficient places. It is a matter which I have no doubt the NTA in particular will wish to take forward over the next year or so.

Baroness Masham of Ilton

My Lords, how many of those places are for children? If the Minister visits a young offenders institution, as I do, he will see many 15 and 16 year-olds. They would be much better in a young persons' residential setting with drug and alcohol rehabilitation. The problem with alcohol is probably just as bad, if not worse, particularly among girls.

Lord Hunt of Kings Heath

My Lords, I do not have specific information on the number of places for young people, although I shall certainly follow that up with the noble Baroness. The concern in this debate has been about whether the national minimum standards will cause real problems for the organisations that provide those places. It is important to remember that at the heart of the Care Homes Act and the national minimum standards is a desire to ensure good quality provision. It is within that context that I pick up the issues raised by the noble Baroness.

The noble Lord, Lord Taverne, thinks that this country is over-regulated and extremely bureaucratic. I am responsible for what is described as better regulation within the Department of Health. I must make two points to the noble Lord. First, although he has expressed concerns about over-regulation, the parliamentary process usually leads to governments being called upon to regulate almost every sector of life in this country. It is very rare that noble Lords ask me to relax regulation. One has to recognise the context in which regulation takes place. The overwhelming pressure on the Government is to regulate.

The interesting point about care homes is that much of the original pressure to pull together the regulation from local authorities into a national system came from the care sector because of concerns about inconsistency throughout the country. I well remember meeting proprietors who had a number of homes in different parts of the country and who were finding it very difficult to relate to individual local authorities, which were inconsistent in their demands.

In general terms, there has been broad support for a national system of regulation but it needs to be proportionate, sensitive and practical. The purpose of the consultation process has been to try to ensure that the standards eventually agreed to were practical and that the care sector as a whole would be able to implement them. I accept that the modifications for the homes that the noble Lord, Lord Taverne, was particularly concerned about took place at a late stage, but at all times during the process of developing regulations and national minimum standards we have attempted to listen carefully to views within the sector to ensure that the standards eventually agreed to were capable of realisation.

I do not need to go into the details set out in those standards. It is clear from the comments made by noble Lords that they and those in the care sector accept that the main points raised have now been dealt with.

However, I ought to deal with one or two other issues, which are apposite to the practicality of the implementation of the standards. I shall focus in particular on funding. I understand the concerns on that subject. In general, we have assured, particularly in the recent announcement, that social services authorities as a whole will receive extra funding. I hope that some of that will be made available to the providers of care homes and that within that care homes that deal with drug and alcohol misuse will receive their fair share.

We have encouraged the development of an agreement, which was announced last autumn, between the Government, independent care providers and local authorities to ensure that there is a common understanding as to how funding is to be provided in the future and the principles on which that funding should be provided. I strongly endorse the hope that local authorities will enter into tailor-made contracts that take account of specific local circumstances and ensure that there is a consistent approach and that care homes are fully aware of the likely funding stream that will come to them over a sufficiently lengthy period.

On the more general issue of care home viability, the Government have commissioned the University of Kent to conduct a review of information on t he supply side of the industry in terms of costs, fees, profitability and number of closures. We hope to publish that fairly shortly. I am sure that it will be very useful in informing the sector and the Government on the more general funding issues and the viability of the sector as a whole. That applies as much to voluntary organisations as it does to profit-making organisations in the sector.

Various noble Lords, but particularly my noble friend Lord Brooke of Alverthorpe, mentioned the work of the European Association for the Treatment of Addiction. I very much pay tribute to its work and its assiduity in expressing concerns about the draft regulations. My noble friend Lord Brooke also asked me about alcohol. We are committed to producing a national strategy to tackle alcohol misuse, and we shall be implementing that strategy by 2004. The strategy's aim will be to influence drinking behaviour by improving understanding of the harmful impact of alcohol misuse. We shall be promoting early interventions for those who are experiencing alcohol problems, and we shall also address the issue of more intensive treatment for those who need it.

This has been a short but extremely interesting debate, and I very much welcome the constructive comments of all noble Lords. I believe that the Government's strategy on drug misuse is beginning to pay dividends. I particularly commend the work within our Prison Service.

I believe that, with the more sensitive approach that we have taken on residential care standards for homes that play such an enormously helpful role in relation to people suffering from drug problems, this is a consistent and effective package. However, we cannot be complacent about the issue; we have to redouble our efforts. We also have to ensure that resources are available. Nevertheless, I believe that this debate has been very encouraging and suggests that we are on the right lines.

House adjourned at three minutes past eleven o'clock.