Health and Social Care Bill

My Lords, I support the noble Earl. He initiated a debate on this question some time ago. As I said at the time, one has to be careful. There are many patients who benefit considerably from some of these medications, when they are given responsibly and monitored responsibly, but that does not always happen. One has to take this particularly seriously because, while those with alcohol and drug addiction often come to the health service for treatment—although perhaps they should come more often—this kind of addiction to prescribed drugs is effectively an iatrogenic disorder. Patients have come to have these medications, and they are not all over-the-counter medications. They are available properly only through doctors, so doctors and the health service have to take a particular responsibility. In that regard, I support the noble Earl in his concerns and I hope my noble friend the Minister will be able to give some reassurance that this is regarded seriously as an iatrogenic disorder that the health service is in some cases responsible for bringing into play through absence of proper monitoring and, in some cases, errant prescribing. However, there is a second component, which is the involvement of NGOs and charities in treatment. When I was a young psychiatrist, I was very interested in alcohol and drug addiction and I worked in a unit. We did not have a specialised unit in Northern Ireland at that time to deal with drug addiction. I looked around in Ireland, North and South, and on this side of the water to find a service that would work. I found a voluntary organisation for addicts. I had myself admitted and went through the whole process as though I was an addict, removing myself from any contact with family and all my worldly goods, as it were, engaging in all the groups and the responsibilities that people undertook, the therapy sessions and so on. It was a very important experience for me because, like some other things that I did, it helped me to see things from the point of view of the patient and the kind of things that we were expecting patients to undertake. However, I was doing it not only for my own interest, but to try to see what services would be possible in Northern Ireland. It became clear to me that, for all sorts of reasons, it was extremely difficult—well nigh impossible—to implement a service of that kind within the NHS, because we put all sorts of restrictions on the NHS. For example, one of the things that was very important was to go and do the washing and the cooking and be involved together in those kinds of things. If you tried to do that in the NHS, you immediately ran into all sorts of regulations, which we frequently discuss in a place like this. So it is not always that easy to do. In a more general sense, sometimes charities and voluntary organisations can bring special things to services that it is very difficult to provide in the context of the NHS. Some of these are experimental and we should wait to see whether they are successful before the NHS takes them on board. That is very appropriate, but the burden of my plea in support of what the noble Earl says is that we should try to ensure that the contribution that is made by charities, particularly smaller charities, and voluntary organisations, which can experiment in these ways, continues to be valued. I have received a number of reports of some of the smaller charitable organisations, in the current climate—not after changes in legislation—finding it increasingly difficult to survive, because they only provide limited services. We have to take this seriously. I do not necessarily say that it has to go in the Bill, but even at this late stage in the evening, the noble Earl deserves credit for raising this question, and I hope my noble friend can give some comfort on it.