Drugs Policy

Lord Mann Excerpts

Tuesday 18th July 2017 Commons Chamber

[Sarah Newton]

My hon. Friend makes an important point. What I would be prepared to do is write to her setting out the range of powers that already exist. I know from my constituency that the police are not always aware of all the civil powers they have, in addition to the criminal powers, to tackle some of the antisocial behaviour associated with persistent drug use. I understand and recognise the challenge she is portraying. The troubled families programme is designed in part to help those families where a drug user has substance misuse problems and, in so doing, help the children living in those households.

[John Mann (Bassetlaw) (Lab)]

We have already had more mentions in the first 10 minutes of the police than we have police officers in Bassetlaw. Will the Minister confirm that we remain the only country in the world, other than the United States, where the Government lead for drugs is in criminal justice, as opposed to health? If the approach is evidence-based, why is that the case?

[Sarah Newton]

I am sure there are many more police officers in Bassetlaw than there are Members in this Chamber this afternoon. I am proud that our drugs strategy is world-leading, and is recognised to be so, because we take this cross-government approach. This is not a simple issue. Tackling substance abuse and preventing people from taking drugs is not a simple thing to do, which is why we take this whole-government, joined-up approach. Our colleagues from the Department of Health are firmly involved in our activity, as is almost every Department.

--- Later in debate ---

[Sarah Newton]

I just do not accept the premise of what the hon. Lady is saying. We do not take it in the way that she describes. We see this very much as a partnership or a joined-up whole Government approach. Of course health and recovery is at the centre of our strategy. It is not a fair interpretation to say that this is led by justice. It is about a joined-up whole system approach. Recovery remains a vital part of the Government’s approach.

[John Mann]

Will the Minister give way?

[Sarah Newton]

I will make a bit more progress. We are absolutely determined to improve support for those dependent on drugs by raising the quality of treatment, and to improve outcomes by ensuring that people get the right interventions for their needs. That means ensuring that they can access the full range of services to help them rebuild their life, which may include mental health, housing, employment and training services, and a lot of support for a stable family life, free from crime. I am pleased that we will appoint a national recovery champion, who will drive progress by visiting different parts of the country to identify good practice and ensure local collaboration. We will also encourage partnership working and transparency by developing a new set of outcome measures to give local areas further support through Public Health England.

For the first time, we are setting out global action. We are already taking a global lead on our psychoactive substance work, encouraging data exchange to give us a richer picture of international trends, and bringing in global bans on the most harmful new psychoactive substances. We will continue our work through the United Nations. We have a balanced, evidence-based approach to drugs. Collaborating with partners around the world will help to give us a better intelligence base and enable us to take better action.

I hope that Members will see that this is a truly cross-Government strategy that requires the commitment and coming together of many Departments. The Home Secretary will establish a new drugs strategy board, of which I will be a member. It will include people from all the key Government Departments, Public Health England, and national police leads. Then we can all plan together to implement the strategy and hold each other to account. I am confident that the strategy is grounded in the best available evidence. We consulted extensively with key partners working in the drugs field, and I am sure that the strategy will make a lasting difference, but we know that there is no easy way to tackle drugs and the harms that they cause, and we need to do much more. Our strategy is flexible enough to enable us to respond to emerging threats.

Finally, by working together across government, locally and nationally, we can genuinely deliver the safer, healthier Britain, free from the harm of drugs, that we all want.

--- Later in debate ---

[Ms Abbott]

My hon. Friend is exactly right, because the purpose of transferring responsibility to local authorities was that they should bring together all the stakeholders, including police and crime commissioners and the local police.

[John Mann]

Will my right hon. Friend join me in condemning the vast number of Labour local authorities that, in 2013, took their drug service out of the NHS and gave it to private providers? That includes mine in Nottinghamshire. Should we not have a Labour party position that would stop them doing this?

[Ms Abbott]

It is unfortunate that many authorities, including many Labour authorities, privatised these services. Privatising them necessarily makes it harder to achieve the co-ordination and co-operation that was the whole point of having these services sit in the local authorities.

Local councils face unprecedented cuts to their funding—anything from 25% to 40% of their entire budget. Is it any wonder that drug-related deaths are increasing when local authorities do not have the funds necessary for comprehensive treatment programmes?

--- Later in debate ---

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to take part in today’s general debate on drugs policy—a very important issue that affects every community, class and creed in the country. The scourge of drugs misuse and its associated criminal and antisocial behaviours has been a blight on too many of our cities, towns and villages for far too long.

Only last week, I conducted a home visit to a distraught family who were coming to terms with the tragic loss of a young man from drug misuse—a thoroughly decent family who had tried to get help for their loved one, but sadly were not successful in time. I will not go into the specific details, but a grieving mother and sister explained about the physical and behavioural changes they observed, and about their loved one stealing from other family members and the general antisocial behaviour that ensued. This story is not uncommon across any of our communities.

That set of circumstances brought home to me why we need aggressively to tackle the forces of organised crime, who are making millions from human misery—effective enforcement against the dealers is a key factor in the war against drugs—while sympathetically addressing the health and safety of users, and with greater emphasis on prevention and harm reduction rather than punitive punishments. Once criminalised, these victims can often face further life challenges and stigmatisation, all of which can result in users finding it harder to recover and to move on from drug problems and addiction, in some cases even trapping them in a self-destructive cycle.

As right hon. and hon. Members will be aware, health and justice, which are key areas in any joined-up drugs policy, are devolved to Scotland. The regulation of all proscribed drugs remains a reserved issue, and the policy is set by the UK Government. There is a strong argument that drugs policy should also be devolved to Scotland. The Minister herself referred to a joined-up, whole-policy approach, and that would be easier to achieve in a Scottish context if we had all the levers of policy. However, the Scottish Government continue to work with the Home Office to implement a series of actions against drug misuse in Scotland.

It is estimated that drug misuse costs society in Scotland £3.5 billion a year. That is very similar to the impact of alcohol misuse, which is estimated to cost £3.6 billion a year. Combined, this amounts to about £1,800 for every adult. In 2008, the SNP Government published the current national drugs strategy for Scotland, “The Road to Recovery”, which set out a new strategic direction for tackling drug misuse based on treatment services promoting recovery. The strategy continues to receive cross-party support in the Scottish Parliament. Evidence has shown that drug taking in the general population is falling, with misuse among young people at its lowest in a decade. However, drug deaths are currently at their highest. The approach taken recognises the importance of supporting families, and the number of family support organisations across Scotland is growing. In addition, several national organisations have been established or commissioned to support delivery of the strategy. They include the Scottish Recovery Consortium, which was established to drive and promote recovery for individuals, family members and communities affected by drugs, as well as Scottish Families Affected by Alcohol & Drugs and the recently launched Partnership for Action on Drugs in Scotland.

The Scottish Government also work with Scotland’s 38 alcohol and drug partnerships, which bring together local partners, including health boards, local authorities, police and voluntary agencies. They are responsible for developing local strategies for tackling problem alcohol and drug use, and promoting recovery, based on an assessment of local needs. A good example is the current Glasgow city health and social care partnership proposals for a pilot safer drug consumption and heroin assisted treatment facility in the city centre. The latest iteration of its business case was presented to the HSCP on 21 June 2017. The facility is designed to service the needs of an estimated 400 to 500 individuals who inject publicly in the city centre and experience high levels of harm. In particular, it is anticipated that the facility will significantly reduce the risk of further outbreaks of blood-borne viruses.

In 2015 there were 157 drug-related deaths in the Glasgow City Council area—up from 114 the previous year—and 132 of them involved an opiate or opioid. The recent rise in deaths is concerning and not unique to Glasgow. I am grateful to the Transform Drug Policy Foundation for its briefing, which informed me that around a third of Europe’s drug misuse deaths occur in the UK. We all need to do something to address this challenge. The British Medical Association and the Advisory Council on the Misuse of Drugs have indicated their support for pursuing safer drug consumption proposals to promote harm reduction. Although that remains a matter for authorities in Glasgow to take forward, the Scottish Government will subsequently consider any formal proposal that is brought to their attention for consideration.

The Misuse of Drugs Act 1971 is reserved legislation, so any proposal is dependent on authorities in Glasgow making a formal request to the Lord Advocate to vary prosecution guidance. It would make sense to devolve all drugs policy to Scotland, to allow the Scottish Parliament to legislate on it and other issues.

[John Mann]

The Scottish Government have followed entirely the Tory Government’s approach on recovery-based treatment, as opposed to NHS treatment. Why would devolving power make a ha’pence of difference, when all the SNP has done is to adopt Tory policies and their consequential failures?

--- Later in debate ---

[Norman Lamb]

I totally agree with the hon. Gentleman, and I was going to mention that solution in a moment. Let me quote Anne-Marie Cockburn—she has been mentioned in the debate—from the Anyone’s Child project:

“I invite the Prime Minister to come and stand by my daughter’s grave, and tell me her approach to drugs is working.”

That is a parent who lost their daughter as a result of the current approach to drug policy.

The claim in the strategy that the increase in the number of deaths relates to a problem of ageing drug users simply will not wash. The same demographic is replicated across Europe, including in Portugal, but the increase in deaths is not, and we have to ask why. The number of deaths per 100,000 of population in the UK is 10 times that in Portugal. I appreciated the Minister’s statement that she would listen carefully to what I said, and I hold her in high regard as well, but when our death rate is 10 times that of Portugal, which has chosen, incidentally, an approach that commands cross-party support in the country, from left to right, surely she should stop and listen. Surely she should investigate further Portugal’s approach, which has resulted in such a reduction in the number of deaths from drug use.

In 2015, 1,573 people died of a heroin overdose in this country. That is shameful. In the past, those people might have been dismissed as victims of their own stupidity, but we can no longer accept such thinking. These are people. They are citizens of our country, and they are losing their lives. They would not have died if they had had access to the treatment rooms that the hon. Member for Glasgow North East (Mr Sweeney) referred to. So why are the UK Government resistant, as I understand they are, to the project proposed in Glasgow, which has the potential to save lives? Surely that should be part of the strategy, but it does not even mention drug use rooms of that sort. Why on earth not, given that all the evidence points towards significant reductions in the number of deaths? No one dies of an overdose when they take their drugs in such safe rooms. Why are we not moving towards that? It is a disgrace, frankly, that we are not.

[John Mann]

Is not the right hon. Gentleman overstating his case? I have visited quite a number of safe rooms across the world and studied the academic research into them. Is it not an overstatement to suggest that nobody dies there? The question of safe injecting is one of the aspects of death, but, as all the Dutch surveys demonstrate, the fundamental determinant of how long someone with an opiate addiction will live is whether they come off heroin and stop injecting.

[Norman Lamb]

I thank the hon. Gentleman for his intervention. The briefing from Transform states:

“No one has died from an overdose, anywhere in the world, ever, in a supervised drug consumption room”.

If Transform has made a mistake, I apologise.

--- Later in debate ---

[John Mann (Bassetlaw) (Lab)]

May I congratulate my hon. Friend the Member for Ipswich (Sandy Martin) on a brilliant maiden speech? It was one of five exquisite, eloquent, factual and well-informed maiden speeches that we have heard today. I have visited all those towns other than Ipswich, although I do hope that, at some stage, I will visit his football club and make it five out of five. I congratulate all five new Members on those speeches.

Interestingly, the facts provided by each one so eloquently are not matched—as is ever the case in a debate on drugs —by the so-called facts provided in many contributions. It always saddens me that, when it comes to debates on drugs, people quote from other people’s briefings rather than do their own empirical research. I could give very many examples of that, but I will confine myself to just one—safe injecting rooms.

I have been to safe injecting rooms in many places across the world. I have been to them in this country. Yes, they do exist in this country—not officially—and they can be effective in some situations for some people. They also have many downsides. The debate about the downsides and the upsides among the very people who run them are part of the larger debate. One of the problems is that they tend to be most effective in the heart of big cities, normally in so-called red light areas with significant amounts of street prostitution. That is where they tend to be most effective for some of the most vulnerable in society. Safe injecting in those places certainly saves lives, but what is found every time is that the majority of clientele who come in are passing tourists. That is because these places are known, they are visible and they are in the middle of big cities—of course those kind of zones are in the middle of big cities.

Sydney provides us with a good example, but there are many others places where that debate on their effectiveness has been a big problem. The ones in the Netherlands, which are not called safe injecting rooms, are not officially designated and are not public, are actually very effective. I call them retirement homes, because that is what they are. Cups of tea are available and the people there are very much of the same age profile—slightly younger—as those in retirement residences or social projects in this country. Clean needles, cups of tea, biscuits and advice are provided if required. The spaces are safe, they work and they save lives.

If we want, when it comes to injection, to save lives in this country, introducing Naloxone for paramedics would, overnight, have far bigger consequences, as has been demonstrated; there are thousands of medical tracts on drugs. The Australians have used Naloxone in dealing with overdoses for the past 15 years; that is why they have far fewer deaths from overdoses. Its introduction in this country would be a major step forward in dealing with deaths.

I came to this subject in 2002, when 13 of my constituents died from heroin overdoses in one year. After a year of research, in which I went around the world with GPs to see what worked and what did not, I overwhelmingly came to the conclusion that what works is not politicians telling each other whether cannabis is good, bad, strong or weak, or what to do with this or that drug; it is trusting the experts—the medical experts.

All the debate today has been about illegal drugs, but probably the biggest single problem in this country, in terms of addiction and the number of people misusing drugs, is legal drugs—prescription and over-the-counter drugs; volume-wise and, I suspect, death-wise, that is a bigger problem. I could not have disagreed more with the Minister when she said that her test for her children—I am trying to quote her exactly—was whether the drug was available at Boots. No; what is available over the counter at Boots or any other chemists is a problem in the war on drugs. The over-prescription of drugs, and the illegal sale of prescription drugs in our communities, is a massive problem that, volume-wise, far outweighs the other problems.

When we talk about drugs, we are not talking about one thing. It is like talking about food; I suspect that a vegetarian would not want to be provided simply with “food” for a meal, if they visited one of us; they would probably want a certain type of food. We should trust medical expertise. In my area, after a battle, I got a system set up whereby if someone had a substance misuse problem—heroin being the biggest one—they went in through the front door of their GP’s practice. It took me six months of battling to make sure that every GP’s practice took part in that, and six months to ensure that it was the front door, not the back door. It took me three months to make sure that it was a GP, rather than a drug worker. Anyone can be a drug worker —there is no qualification for being one—but not anyone can be a GP; the standard, in my view, is satisfactorily high in this country.

Guess what we found? There has been a lot of talk of rehabilitation, but I will tell hon. Members the biggest rehabilitation that someone on heroin can get: it is going through the front door of their GP’s practice, like everybody else in the community—like their mother, father, brother, sister, and sometimes their kids. It is going through the same door and seeing the same GP. Strangely, that is rehabilitating and normalising. It takes people back into society—and it is dirt cheap: the biggest single cost of this in my area is from the dental treatment, because those with a significant substance misuse problem do not tend to go to dentists. They go into treatment; I do not know what the treatment is, though I know some of the modalities, but the treatment is not my decision, or the decision of a politician, a councillor, the police, the criminal justice system, or a drug worker; the GP decides on the treatment. Strangely, these people wanted dental treatment; that was the highest single cost. Strangely, people who have had dental treatment have a far better chance of getting through a job interview than those who have had no treatment for five or 10 years. A job means a bit more rehabilitation, and if the local council has its act together it can provide proper housing.

What happens when people have better teeth, the ability to go to their GP through the front door, a job and secure housing? What we found was that people stopped dying. There were 13 deaths in 2002, and over the next 11 years there were two. Vast numbers of people got back into work; they paid taxes—they were in rehabilitation. Forget the statistics that the Government give out about who is in treatment and who is not—I will talk in a moment about how the system has fiddled the figures since 2010—because a good statistic is the number of people paying taxes.

What is the saving? It is hard to quantify, but I can certainly quantify one thing. In 2002 the yearly average for the number of overdose admissions to Bassetlaw hospital was 170, each of which cost £4,000. That yearly average was immediately reduced to under 40, and it stayed like that for the next 11 years. That meant a saving of £500,000 a year for a small hospital. Some people were worried that the hospital would need security staff and cameras, to guard against all the drug addicts coming in, but there were far fewer drug addicts, far fewer overdoses and far fewer hospital admissions. That meant a direct saving. Remind me, Mr Deputy Speaker, which constituency had the biggest fall in acquisitive crime in the whole of the United Kingdom?

[Hon. Members]

Bassetlaw!

[John Mann]

Mr Deputy Speaker, you are ever wise, ever accurate and ever factual. Bassetlaw saw a 400% reduction in acquisitive crime. Why? Because it was the drug addicts committing most of the crime.

For 11 years people could go through the front door of their GP’s surgery. Not everyone was happy. I have read the medical advice—not all of it, but hundreds and thousands of papers—and basically there is a two-thirds success rate for chronic relapsing illness, meaning that two thirds will be sorted, wherever the illness is, and a third never will be. There is a cohort of people who will always have problems, and they tend to go in and out of prison regardless, but there are far fewer of them because we have reduced the number by two thirds, leading to huge savings.

That does not totally solve the problem, but it allows the rest of the community to get on with their lives without being plagued. Pensioners were not having their windows smashed every five minutes by people who stole a fiver—the normal heroin theft is to break a pensioner’s window and grab the first thing in sight. The fear and the cost of repairing the window is far bigger. Frankly, I think that if most pensioners knew they would just leave the fiver outside. That is what life was like.

What do the Government do? Two things. First—this is a big improvement in this new drugs strategy—they say, “Recovery, recovery, recovery. We are not going to bother maintaining anybody.” That change is vital. That is what they did in the Netherlands, France, Sweden, Australia and New Zealand—in fact, in every country I went to. They all left it to the doctors.

In 2002 only three countries did not have health authorities in charge of drugs policy: the United States—obviously—us and Iran. When I went to Iran to talk about drugs policy, I found that they had just changed it. They had done that—this is my assessment, not what people there said—because, basically, all the drug addicts had been sent to be looked after by the religious leaders, who would put them in recovery. But it did not work, which was undermining the religious leaders. So those at the top in Iran sent people over to Australia to study the medical system there, and they came back and introduced it in Iran, which therefore now has a medicalised system—and there are big improvements. You see, doctors are rather good at treating people because they know what they are doing. Yes, they sometimes use methadone or buprenorphine treatments, and sometimes they bring in mental health therapies, but the system worked well through the NHS.

What have we done? In 2010, we threw all that out the window and gave it to the local councils, and all of them—including Labour councils—in their great stupidity privatised it. What do those Labour councillors say? “We know better than the GPs and the NHS. It’s got to be joined up. It’s got to be more than the NHS.” So they took it away from the NHS and, since 2013 in my constituency, people have not been able to walk through the front door of their GP practices.

Guess what has happened? I had a meeting on Saturday, in Retford. There have been hardly any burglaries in Retford in the last 100 years, but there are record numbers this year. Who is committing them? The druggies—people who are drug addicted but cannot go through the front door of their GP practice as they could before. I cannot get them in. I used to guarantee to every family: “I’ll get you an appointment within a couple of days.” And I did, and it was easy. They went in and saw their GP. They engaged with their GP, and it was hugely successful.

My recommendation to the Government and to my own party—perhaps my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) will pass this on to my leader—is to put this portfolio in health. That is what the Labour party policy review that I chaired in 2009 recommended, and it had 4,000 submissions. The leader at the time and the one after him ignored it. Third time lucky. Put the portfolio in health and say that a critical part of the policy is that the NHS—primary care GPs—will manage the patients. Say that people in this country have the right to be treated by their GP. Yes, more is needed from other services—absolutely: getting people into jobs, keeping control of crime and getting people into stable housing, but the NHS is at the heart of the issue.

By the way, why on earth have the Scottish Government moved away from their successes a few years ago in places like Glasgow towards this nonsense of people coming out of the recovery system after six months? The Government said, “Six months and that’s it—out you come.” That appears to have changed.

[Sarah Newton]

indicated assent.

[John Mann]

If it has, that is brilliant, but we should never have gone back to that nonsense in the first place; I am sure the Minister will blame the Liberals. That is what we had in 2002: the revolving door. “Oh, you’re out—you’re clean.” “Who says I’m clean?” “Well it’s six months. You have to be.” It was a bit like how it is in the prisons: strangely, someone has some Naltrexone and “Oops! You’re clean!” That is the stats fiddled. Frankly, I could fiddle those stats. It is the system that does it. Totally meaningless.

Let us have a bit of honesty. We would still have a problem. We would not get rid of it all. Dealing with Spice is not as straightforward as dealing with heroin, and the GPs do not have all the answers. But if someone with an addiction goes to a GP, the GP pulls in mental health services, and that does work. Across the world, people have found that. So let us not misquote what happened in Portugal, where I have been, because what I am talking about is the key to that system. Let us not misquote what happens in the Netherlands, where they have kicked out most of the coffee houses and they specifically demonise heroin—very sensibly at the time, in my view. The position for quite a while was, “Our problem is heroin. Do what you want, but you’re not doing heroin”, and they got on top of it. We are not in that situation, so we do not need that kind of overly crude approach. We can look at what the Swedes do and what the French do. In France, the GPs will not do it. With single-practice GPs working from their own home, it is easy—go to the local chemist and get the prescription, and do not even bother supervising it. Do not complicate it, that is my advice, and then we will get better results.

I can only give it as I see it. I have got the documents—the research is there. To new colleagues in all parts of the House, I say, “Read the assessments of what has happened, because there is a plethora of materials that demonstrate this.” We will not get rid of the problem, but we can significantly be on top of the problem. There are some improvements, but frankly not enough. Yet again, the Home Office is the wrong Department. Of course the police advisers all want to decriminalise drugs, because it gets crime down. I have heard this for 15 years: “If we decriminalised and didn’t arrest, crime would come down and the problem would be solved.” No, that is not the answer. Lots of good stuff could be done in terms of how we police and do not police. There are lessons we could learn from abroad.

The starting point is to shift the portfolio to health. We should be bold enough to say, “It doesn’t fit in with how this place works, but we’re doing it anyway. When we’re in power the portfolio will be in health.” That in itself would transform the situation in this country because then we would have to make sure that primary care is funded and would be able to stop wasting money elsewhere. Local councils: love them or loathe them, they haven’t got a clue—big error. We should tell our Labour councils, “Stop privatising and give it back to the NHS.”