HC Deb 31 March 2004 vol 419 cc480-8WH 3.45 pm
Mr. David Laws (Yeovil) (LD)

I am very pleased to have secured this short debate about drug rehabilitation services in Somerset, and I am delighted to welcome the Minister. He may be aware that I have already met his colleague, the Under-Secretary of State for the Home Department, the hon. Member for Don Valley (Caroline Flint), and we discussed the issue on 27 January. Therefore, some dialogue has already been opened up, but I appreciate that drug services is an issue on which there is partnership between the Home Office and the Department of Health. I am therefore very pleased that a Health Minister is present.

The Minister knows that I was keen to secure the debate because there is something of a crisis in access to drug rehabilitation services, particularly in South Somerset. I am very pleased that my hon. Friend the Member for Somerton and Frome (Mr. Heath) is present because we both represent that area.

The Minister may know from the briefing that he has received from the National Treatment Agency for Substance Misuse that the waiting time to access drug rehabilitation services in South Somerset is way over the levels set by the agency, way over the targets set by the Government and way in excess of the waiting time that we want for the very vulnerable people we are talking about.

Perhaps I can highlight for the Minister two issues about access to services locally that give me most concern. The first statistic is the national target for the maximum acceptable waiting length for specialist prescribing. The Minister knows that, through the NTA, the Government have set a maximum waiting time of three weeks. That seems to be a sensible figure and it demonstrates that they want to give priority to people with serious drug misuse problems and get them into the system as quickly as possible. In Somerset, against the access target of three weeks, the average waiting time is 14.3 weeks. In South Somerset, the current average wait is 36 weeks, with the longest being 40 weeks. Those figures are very unsatisfactory and way above the time limit that the Government have set.

I received a letter from a consultant psychiatrist in substance misuse who works for the Somerset drugs service and assists many of the individuals who require access to the service. On 9 January, he wrote to me to say: Whilst access to prescribing is currently determined by an assessment of risk I have been told to prescribe only to those within the Trust's red band on the risk matrix. This is defined by people who are at possible risk of unexpected death or likely or certain of permanent injury or serious assault on others. Excluded are those who are at possible risk of semi permanent injury, violence, aggression or self harm. The threshold … is at considerably above what I would consider to be the clinical requirements for immediate prescribing. There is therefore a very serious problem in Somerset, and especially in South Somerset.

Mr. David Heath (Somerton and Frome) (LD)

I concur with absolutely everything that my hon. Friend has said. A third issue is recidivism in the criminal justice system. Recently, I spoke to a constituent who was a habitual criminal in order to pay for his drug habit. He had been released from prison and had returned home desperately wanting to get off drugs and find a way of escaping from a life of crime, but he will not receive treatment for the best part of a year. Inevitably, he will slide back into criminal behaviour unless he is helped. Is not that another factor that suggests that we need a much better service?

Mr. Laws

My hon. Friend is right. It is because many individuals with such needs have come to my advice centre in the past three to six months that I have taken up this issue. It is not only the individuals and their families who suffer as a consequence of the lack of timely access to drug rehabilitation services. It is almost certainly the case that the crime levels that we are experiencing in Somerset, in particular, are inflated because many people who have serious drug misuse problems are offending to fund their addiction. What is more, those people tell us that that is precisely what they are doing.

I acknowledge the progress that the Government have made since they came to power in 1997. The prime purpose of this debate is not to apportion blame among the various agencies in Somerset and the Government. I acknowledge that many people across the country are now receiving drug rehabilitation treatment. There has been a significant increase in the number, particularly since 1998.

I also wish to pay tribute to the work of the many agencies in Somerset, not least the drug service, the primary care trust, which seeks to work in partnership with the drug service, and the drug action team. All those agencies are trying to get on top of the problem, but in the past few months there has been too little progress in reducing the scale of it.

As my hon. Friend said, we have seen many individuals in our advice centres in the past three to six months who have come to us because they cannot get access to drug rehabilitation services at precisely the time that they need them. Ministers in the Department are on record as having said during the past few years that they want a service that will allow people, when they are ready, to access in a timely fashion the drug rehabilitation assistance that they need. We do not have such a service at present.

I have seen in my advice centre in the past few months individuals with a serious criminal background who tell me that they continue to offend to fund their illegal drug addiction because they cannot get assistance through the drug service. They have come out of the criminal justice system and are trying to re-establish their lives and their family's stability, but they have gone back on to drugs because they are not able to get support from local services. I have also seen individuals outside the criminal justice system who have been told that their best chance of getting access to drug rehabilitation services is to commit an offence so that they can be put through the criminal justice system and then perhaps be fast-tracked for drug treatment and testing orders.

Most tragically, I have seen individuals such as the parents of a young man who tried to commit suicide a few months ago. He is now in Yeovil district hospital with severe brain damage, having failed to get drug rehabilitation assistance when he needed it. Obviously, the details of that case must be investigated to establish precisely the reasons behind his actions, but it cannot have been a helpful factor that access to drug rehabilitation services is as constrained as it is.

Of course, all those individuals have a responsibility to themselves and to society to tackle their problems of misuse. We must not put all the blame on agencies, the Government and others. However, we have a strong interest as a community in resolving the problem, not only because of the effect on individuals but because of the effect on our community of higher crime levels and the effect on families of members who have drug misuse problems.

The figures that the Somerset drugs service sent to me yesterday and which I cited briefly at the beginning of the debate are horrific, particularly for the South Somerset area. I go back to specialist prescribing, which is where much of the pressure is. The waiting time limit set by the Government is three weeks, but the average waiting time in Somerset is 14.3 weeks, and that in South Somerset is 36 weeks, which is horrific. The Government's target for shared-care prescribing is, again, three weeks, but the average for the county is 6.5 weeks and that for South Somerset is 14.5 weeks. The Government want people to have assessments within a couple of weeks, but it takes roughly double that in Somerset and South Somerset. The local agencies and the Government face a huge challenge in dealing with the problem.

The waiting list for access in Somerset at present stands at 118 people, of which three quarters are waiting in the Yeovil area and in South Somerset. Therefore, there are particular difficulties in those areas. As a result, only priority and perhaps even only top-priority cases are being seen. People are being seen for assessment but not for treatment, unless they fall into the category of suicide risks or are pregnant women. That leaves out a huge range of people with really serious needs, some of whom pose a serious risk to society because of their drug addiction habits and the criminal activity needed to fund them. A huge range of people are altogether outside the system, including serious drug addicts, who are having to wait months on end—up to six, seven or eight months—to access treatment.

The Minister will probably know some of the reasons for the problems that we have in Somerset, which are rather well set out in a letter from the consultant psychiatrist in substance misuse whom I cited earlier. In his letter to GPs in the South Somerset primary care trust area on 9 January, he explained the background to the problems there: Last year we undertook a review of SDS prescribing policy. Our revised approach was consistent withModels Of Care (a National Treatment Agency document which in effect is a National Service Framework for drug services). We moved from an abstinence orientated service to one espousing harm reduction as a primary goal. We now aim to maintain people within treatment whilst offering a range of prescribing options within an evidence based framework. This policy was launched and endorsed at a multi-agency seminar in February 2003. At that stage and indeed subsequently SDS managers highlighted the prescribing cost implications. At an operational level the strategy has proved successful in so far as we have increased the numbers of people in treatment by almost 100 per cent. I am afraid, however, that in the first half of the last financial year the Somerset drug service was so successful in getting people into the service and dealing with their needs that its prescribing budget, which was only £130,000 for the whole county, ran out about halfway through the year. At that stage, the service was still willing to continue assessing people but could not provide any treatment. That is why we now have such horrendous figures for waiting times, which are probably among the worst in the country—at least I hope that they are, because I would not want other areas to be experiencing worse problems.

We must consider what some of the solutions to the problem might be. The local agencies are already doing important work to help deal with the problem on the ground. The prescribing budget is to be increased in the next financial year by about 50 per cent., from £130,000 to £200,000. I believe that that uses some of the money from the Home Office's criminal justice drive to improve drug rehabilitation services for offenders. However, that may be of less use to those without an offending history. There will be more work locally with the primary care trusts to provide shared care and nurses. There will also be a shift in the staffing resources in Somerset, away from some of the areas that have lesser problems and towards South Somerset.

Significant problems are likely to remain, however. First, although the increase in the prescribing budget sounds quite impressive, it will be enough only to stabilise the existing number of people being dealt with. It may well not be enough to clear the backlog. Secondly, shifting resources in Somerset to South Somerset may improve the situation, but at a cost to other areas in the county. There is also a wider budget problem, in that the drugs action team budget for Somerset is to increase only by 0.07 per cent. in the financial year 2004–05. That will make it difficult to put the resources into prescribing, residential rehabilitation and other forms of treatment to improve the situation on the ground.

At my last meeting with the Under-Secretary of State for the Home Department, she pledged to look into the problem. She wrote back to me on 26 February to clarify that she accepted that we have a serious problem in Somerset and that she had asked the National Treatment Agency for Substance Misuse to look into the situation and to prioritise the waiting times in Somerset. She said that she had asked to be kept informed about progress on the issue. Does the Minister here today accept that there is a serious problem in Somerset and in South Somerset in particular? What can he do to encourage the NTA to take a proactive approach along with the local agencies to resolve the problem?

At present, we are in an unsatisfactory position, which is putting many people and their families at risk. It is also increasing the level of crime across the Somerset area and in South Somerset in particular. It will undoubtedly cost money to resolve some of the problems, but if we continue to allow them to go unresolved, it will be even more expensive to us in terms of broken families, failing services and the increase in crime that will result.

4.1 pm

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman)

I congratulate the hon. Member for Yeovil (Mr. Laws) on securing a debate on this important topic. He and the hon. Member for Somerton and Frome (Mr. Heath) raise valid concerns about service levels in their local communities.

From the remarks of the hon. Member for Yeovil, I know that he shares the Government's belief that effective drug treatment is vital if we are to drive down the misery and damage to society that the misuse of illegal drugs causes. The Government have shown themselves to be prepared to back up that belief with substantial extra funding. In this financial year, the pooled drug treatment budget has risen to —243.6 million, which coupled with substantial increases last year means that, in the past two years alone, local drug action teams have received average increases in funding well in excess of 50 per cent.

The Government's view that treatment works is supported by research. The national treatment outcome research study, the most important UK research into drug treatment, shows the enormous benefits to both society and those individuals who complete treatment. From an economic perspective, the findings have shown that every £1 spent on treatment saves £3 of expenditure in the criminal justice system. That finding alone would have been enough to persuade the Government that increasing the public money spent on drug treatment was justified and that helping individual drug users was cost effective for the population as a whole.

In addition, the national treatment outcome research study showed that the longer we are able to retain an individual who misuses drugs in treatment, the more likely it is that a successful outcome will be achieved. One of the key measures of whether additional funding is being used effectively is the Government public service agreement on treatment, which set a target of doubling the number of users in treatment by 2008. I am pleased that the latest figures, published in December 2003, show that the estimated numbers in treatment during 2002–03 increased by 41 per cent. against the estimated baseline of 100,000 in 1998, which means that we are on track to achieve our target.

The new funding that the Government have made available for drug treatment, to which the hon. Gentleman was kind enough to allude, needs to be spent effectively and that is why the National Treatment Agency for Substance Misuse was established in 2001. The NTA was created to set standards for the provision and commissioning of drug treatment performance and to monitor and tackle variations in treatment standards and availability wherever they occur.

One of the areas that the NTA has prioritised is ensuring that there are sufficient trained staff to work within treatment services. To address that issue, the NTA is implementing a work force strategy to encourage professionals to work in the field of drug treatment. That is already having a substantial impact, with the NTA reaching its 2008 target of 9,000 drug treatment workers by December 2003, an increase of more than 30 per cent.

We also recognise that we offer as much support and guidance as is possible for those groups who are providing treatment to drug misusers. Examples include the clinical guidelines on the management of drug dependence published by the Department of Health in 1999.

We have also developed guidance on the optimum models of care for drug treatment services. That document is known as models of care. It aims to provide the national framework for drug misuse services in England necessary to achieve equity, parity and the commissioning and provision of substance misuse care and treatment. It has the status of a national service framework.

As part of models of care, the NTA has required all areas to publish local care pathways by April 2004. I believe that that will be a major step forward in the delivery of drug treatment services across the country. In addition, the Department of Health has made £3.6 million available to the Royal College of General Practitioners to allow it to develop a course to assist health care professionals to develop the skills needed to work with drug misusers. The funding has meant that more than 1,000 health care professionals have been able to undertake the accredited training course.

Agreement has been reached for drug treatment in primary care trusts to be subject to the Commission for Healthcare Audit and Inspection star rating system. That means that drug treatment is now one of the national health service's top 10 priorities. As part of the work of setting standards in drug treatment services, the NTA is providing specialist advice to CHAI. The Under-Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson), who has responsibility for drug treatment, has also asked the NTA to explore the potential for developing a joint inspectorate programme with CHAI.

Overarching all the work that the NTA does is the need to reduce the time that anyone who needs drug treatment has to wait before their treatment begins. That is crucial as a delay in offering treatment can lead to the drug user losing their motivation to enter treatment, so that by the time a place is available, they are no longer interested and the opportunity has been missed. That is why, in December 2001, the NTA, working with the NHS Modernisation Agency to ensure that the targets were consistent with work going on elsewhere in the NHS, set maximum waiting-time targets against which drug action teams are being measured. Although there is some way to go, with delays in accessing treatment unacceptably long in some parts of the country, the overall trend is positive, with waiting times reduced from eight to 11 weeks to two to four weeks in most parts of the country. We are convinced that those waiting time reductions have had a substantial impact in reducing the numbers of drug misusers who are referred but who fail to enter treatment.

We now come to the issues that will be of real concern to the hon. Gentleman. One of the effects of a reduction in waiting times is that demand for treatment increases, as fewer users drop out while waiting for treatment. That is an issue that has been identified across the country. As part of their planning, drug action teams are expected to include an expectation of increased demand for treatment as a result of a reduction in waiting times. That seems to be at the root of the problems that have been encountered by the Somerset drugs service. I accept that local agencies should build in plans to cope with increased numbers seeking treatment as a result of the reduction in waiting times. However, I understand that the increased demand in Somerset was far in excess of anything experienced elsewhere in the country. To put that into context, if drug action teams are to ensure that the Government meet their target of doubling the numbers in treatment by 2008, they need to increase the numbers in treatment by approximately 10 per cent. a year. The Somerset drugs service had 287 active clients in July to September 2002, but the number had risen to 426 clients by the same quarter of 2003. That is an increase of almost 50 per cent. in one year, which is five times the national average increase.

Mr. Laws

I understand the Minister's point entirely, but one could derive two conclusions from that big increase in demand. One could be that there are significantly worse drug problems in part of Somerset than in other parts of the country. The other could be that the Somerset drugs service has been too successful in taking into the service many of the drug addicts out there. In either situation, the solution must surely be more funding to enable the service to deal with those individuals rather than push them away.

Dr. Lady man

The hon. Gentleman is right. In many ways, the problem has been generated by success. It highlights the fact that we needed to start introducing these programmes and these substantial increases in expenditure to try to address what was clearly a hidden problem. We cannot simply turn a tap on and solve these problems overnight. That takes time. A particular problem arose in Somerset that is out of kilter with similar effects elsewhere in the country. We must examine the Somerset experience and ask ourselves how that needs to be managed in order to resolve it.

As I said, the fact that there should have been planning in no way removes responsibility from the local agencies to continue to reduce waiting times and to provide the treatment places needed. The hon. Gentleman voiced concerns about a particular local problem that needs a local solution. The NTA regional office, the Somerset drug action team and the Somerset drugs service have been working together to ensure that that happens. Delays in access to treatment are unacceptable. Delays in being able to offer treatment can lead to the drug user losing the motivation to enter treatment.

I know from a meeting that the hon. Gentleman had with the Under-Secretary of State for the Home Department, my hon. Friend the Member for Don Valley (Caroline Flint) and from a subsequent written response that he is aware of the high priority that has been given to tackling these problems. Partners at a local level have been active in putting in place short and medium-term strategies to address some of these problems. For example, the Somerset drug action team opted into the opening doors programme run by NTA and the National Institute of Mental Health for England, which will help to modernise services and to reduce waiting times. It has improved operating procedures in line with the opening doors programme to ensure a more consistent approach to the delivery of drug treatment services. A data collection system has been established to monitor waiting times more accurately. This has also meant that we have, for the first time, accurate data on geographic areas that were not available before. The team also invested in two peripatetic nurses for the Somerset drugs service in 2002–03 to help to reduce waiting times. They are currently working in the high waiting time areas to increase capacity. In addition, the drug action team commissioned a strategic review of the adult drug treatment system. The final report makes clear recommendations about reconfiguration of service provision, and the team will act on those recommendations in 2004–05.

Mr. Laws

Will the Minister give way?

Dr. Ladyman

I have only a couple of minutes left, and I have a few more comments to make.

There has also been additional funding from the drug action team. In 2002–03 and 2003–04, increases in funding were made available to the Somerset drugs service. In 2004–05, –205,600 will also be made available for prescribing, which will provide another 74 places. That represents a growth in capacity of 56 per cent. since last year. Further increases in investment are expected in future years.

The NTA and the strategic health authority will work together to strengthen the commissioning of drug treatment services in Somerset to ensure that this particular local problem is overcome and that commissioning arrangements are as robust as possible. I have been asked to ensure that the hon. Gentleman and Ministers are kept fully informed of developments. I will also ensure that the hon. Member for Somerset and Frome is also appraised of progress and that they are both consulted on planned changes when appropriate.

It is always easy to blame a lack of resources for any problems that occur in the provision of services, but I do not believe that the concerns that the hon. Member for Yeovil expressed today about drug treatment services in Somerset can be explained simply by a lack of funding. The formula used to allocate funds will always mean that those areas with the greatest social and economic need will receive the largest increases, and I am sure that all Members will appreciate why that is so. This has meant that Somerset does not receive as large an increase in its pooled drug treatment budget allocation as some other areas of the country. Nevertheless, investment in drug treatment services in Somerset has increased by 47 per cent. in the past two years. The increase in 2004–05 may be very modest, but it was announced in advance so that it could be planned for, and Somerset will receive an additional 11 per cent. in 2005–06.

I again thank the hon. Gentleman for giving me the opportunity to speak on this important issue. I hope that what I have said today makes it clear that the Government are committed to access to effective drug treatment services throughout the country, and that we are committed to helping to ensure that urgent remedial action is taken where that access is lacking. I hope that he is at least partly reassured that we are aware of the problems in Somerset and that we determined to put them right.