Debate on the Address

My Lords, I am delighted to follow the noble Lord, Lord Morrow, and to have the pleasure of congratulating him on behalf of the whole House on his maiden speech, which focused particularly on education and the future of Northern Ireland. He has a long record of political and public service in Northern Ireland and I am sure that he will soon make an impact in this House, too. As an auctioneer and estate agent, he will have particularly noted the Government’s Consumers, Estate Agents and Redress Bill, and I am sure that we can anticipate a positive contribution from him when we come to debate it. I am sure that he will also give us the benefit of his experience and intelligence on a wide range of other topics in future. We extend to him a warm welcome to our deliberations. In supporting the Motion on the gracious Speech, I shall speak about health. I am pleased that, after much consultation and analysis, the Government have again tabled a Mental Health Bill. It may not be enough for everyone, but I hope that this time it will be possible to get some much needed changes on to the statute book. My particular concern is with drug and alcohol addicts who sometimes have to be sectioned. Today, I want to take a liberty similar to that exercised earlier by the noble Lord, Lord Fowler, and use this opportunity to draw to the attention of noble Lords a serious problem in this field—the significant number of beds in residential drug and alcohol treatment centres that are reported to be empty. I preface my remarks by acknowledging that this Government have made more money available than any Government before and have made a determined effort to achieve their drug strategy aims. They are to be congratulated because, since the strategy was published in 1998, much has been done to improve the availability of and access to treatment for drug users. However, the residential treatment sector has been largely neglected for the past eight and a half years. This is in spite of the impressive evidence to indicate that this sector achieves some of the greatest treatment gains while treating people who present with the most severe problems and complex needs. Recently, the Department of Health, the Home Office and the National Treatment Agency made it clear that as a matter of policy they expect to see an increase in the use of tier 4 services. However, rather than experiencing an increase, a significant number of established providers in the voluntary sector have experienced a steep and sustained downturn in funded referrals since the beginning of the financial year. Current capacity is underused by up to, and even beyond, 25 per cent on any given day in some centres. This situation has developed over the last year and has become much worse since April, in spite of a 28 per cent uplift in already substantial funds passing from the National Treatment Agency to local commissioners. The crisis is having a severe financial impact on providers. Some services have already closed and, if the typical autumn and early winter decline in referrals comes on top of this, others will follow. Once lost, they and all their experience will not be easily recovered. Severe damage will have been inflicted on this important national resource and on the country’s ability and capacity to treat effectively drug misusers and alcohol-dependent people. Indeed, some high-quality structured day treatment programmes have been similarly badly affected. This dire situation coincides with an announcement by the Department of Health of a capital investment programme of £54.9 million to increase capacity in the tier 4 sector, to create more beds. While prima facie this is a move in the right direction—and in normal circumstances I would wholeheartedly welcome it—it does not make sense to launch it when currently capacity is significantly underused. This needs addressing first and urgently. Adding more beds will only exacerbate the current problem, especially as revenue appears inadequate to sustain existing provision. The risk of wasting a large amount of public money in this area is very high indeed while many unfilled beds exist. From conversations with Ministers from the Department of Health, with the European Association for the Treatment of Addiction—with which I declare a connection and an interest—and with some of the treatment providers, I know that action is currently being taken to try to establish the gravity of the position. There have been some disagreements about the seriousness of the crisis, and questions have been asked about the failure of some of the providers to report a clear picture of the occupancy levels, the relevance of the department’s data-gathering operations and the accuracy of some of the data. Although there may be problems over the data, we have to recognise that the people at the sharp end who are running the treatment centres know whether they have empty beds that should be filled. They know whether they have to close down their facilities—and some are currently having to be closed. Unfortunately, it is they who at the end of the day will have to sack employees. They are fully aware of that, notwithstanding what civil servants or the department may say about the data. It has been suggested that treatment demands may be changing and that that is why some beds remain unfilled. First, I find that difficult to accept. There is little evidence of it happening in the private sector, where it is clearly recognised that, even at very high costs, residential treatment offers the best chance of quality, lasting recovery. While the private sector is still bringing in so many people, I am not convinced on that score. Secondly, if there is a case for a change in direction, I find it rather odd that the Government are contemplating injecting nearly £55 million extra into creating even more beds. So a number of questions need to be asked. I told my noble friend—and I forewarned him that I may not be quite on the gracious Speech all the way through my address—that I would pose a number of questions. If he cannot answer them today, perhaps he will take them away and, in the light of the House’s interest in this subject, send me a reply that will subsequently be placed in the Library. First, what is the latest position on the review that is taking place? Secondly, will any emergency revenue funding be provided to secure the current capacity in the existing sector as I have described it? Thirdly, does he believe that it is wise to proceed with a capacity-building programme with an injection of nearly £55 million if it does not take into account the long-term availability of sufficient revenue to sustain the beds once created? We should also be asking why this is happening. The truth is that there is no one simple reason for the problem—or one simple solution to it, probably. We know that there are long-standing structural and systemic faults in funding and arranging residential treatment, which, despite eight and a half years of the drug strategy and five and a half years of the NTA, have still not been properly addressed. The harmful effects of the historic neglect of the valuable national resource that is residential treatment have been compounded by the treatment policy of the past five years, which has resulted in an embedded methadone-prescribing culture that seldom presents the alternative of abstinence in a positive light. We now sustain thousands of addicts in the methadone cul-de-sac funded by public moneys. This has severely limited the number of people given the chance to exit from dependence—a principal aim of the drug strategy. The situation has been exacerbated by pressure on commissioners and purchasers to meet what I suppose I would describe as headline-grabbing targets, which relate to the quantity—numbers of people being treated—rather than to the quality and effectiveness of that treatment. Is it not ironic that current policy puts addicts on to methadone to avoid them self-harming and to reduce the risk of them committing crime to fund their drug dependency? Yet they still commit crimes and are still sent back to prison and, as we have seen in the past two weeks, they can now successfully sue the Home Office for damages if they are not allowed to stay on methadone while in prison. What a contradiction and what a crazy world we appear to be living in. Some of these fundamental issues must be revisited to look for alternative solutions. We have come a long way and made great progress, but there is much more work to be done. I believe that we can in some areas get some sanity back into elements of the policy. Residential services have a good level of success in getting addicts to recover and in achieving long-term sobriety. They should be given more support than they have hitherto been given by the Government and the National Treatment Agency. I conclude by suggesting the introduction of a system of core funding, as is common in other European countries. This would take the form of approved and registered providers receiving an annual amount of funds in return for which they will contract to provide an agreed number of beds and treatment episodes. This should be provided by creating a national ring-fenced budget allocation administered through the National Treatment Agency and the PCT network. That would greatly reduce the bureaucracy, which has increased apace in recent years, and get the money to where it is needed—at the front line, treating the addicts.