Health Inequalities

Debate between Dan Poulter and Jonathan Ashworth

Wednesday 4th March 2020 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Thank you for calling me, Madam Deputy Speaker, and I draw your attention to my declaration in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who is absolutely right to highlight the fact that health inequalities and their determinants go much wider than the NHS. We are talking about issues to do with housing, poverty and employment. We know that poverty and deprivation are associated with poor health outcomes, both physical and mental, and health inequalities.

In that respect, some of what I am going to say will ask the Government to revisit legislation that we passed as part of the Health and Social Care Act 2012 in relation to addiction services. That is where I shall concentrate my remarks, because we are all aware that addiction services treat some of the most vulnerable people in society, but face particular challenges and treat people often with some of the lowest life expectancies. In that respect, we must recognise that the changing commissioning arrangements, the move towards commissioning of addiction services by local government and some of the funding restraints that are present in the system have impacted on the quality of service delivery.

I shall touch on Dame Carol Black’s report later, but we have seen that, in some areas, there is now minimal provision in many addiction services, and local authorities often look towards the lowest bidder to provide their services. I hope Members on both sides of the House think that is not necessarily a good thing, because we want to see effective addiction services that make a difference for patients and for the people who need them. What we see, though, is that services have deteriorated over the past few years. Services have become increasingly fragmented, and the numbers of dependent opioid users and opioid deaths are rising. That may well be because there are greater medical comorbidities in that particular group, and the age profile may be associated with a higher mortality rate.

Dame Carol Black’s report makes some important points about the challenges. She includes a timeline that indicates how addiction services have been delivered, and she highlights that in 2005, under the previous Labour Government, a ring-fenced, pooled treatment budget was created, centrally funded and allocated on need. Additional funding contributions were made by local authorities, the police and the NHS. Funding increased from £50 million to nearly £500 million during the 2000s, which saw a step change in the ability of addiction services to respond to the needs of local populations.

The biggest change in the delivery of addiction services came with the Health and Social Care Act, in which responsibility for the commissioning of drug and alcohol services moved to local authorities. I do not need to rehearse many of the arguments, but it is worth highlighting some of the challenges we now face. A number of those challenges are a direct consequence of that change in commissioning arrangements.

Overall funding for treatment has fallen by 17%. It is not possible to disaggregate alcohol and drug treatment spend, but many local authorities will have reduced expenditure on drug and alcohol treatment by far larger amounts, with residential services—that is in-patient facilities—being particularly hard hit. The report says:

“Likely many areas are now offering the bare minimum service with large increases in worker caseloads an inevitability. The overall numbers in treatment have fallen at a similar rate as funding with the largest decreases seen in opiate users (and those in treatment for alcohol only).”

At the same time, we are aware from Home Office data that the prevalence of opiate and crack use is increasing and that the number of opiate users in treatment is falling, so there is a challenge for the Government to address in how those services are delivered and commissioned.

We should also recognise that many people who are in need of addiction services have two or more other complex needs. From Dame Carol Black’s report, we see that over 70% are unemployed, close to 40% also need mental health treatment, over 15% are homeless and over 25% have been referred from the criminal justice system. She states:

“Over 60% of opiate clients have two or more complex needs alongside their drug use”.

In the brief time I have left, it is worth reflecting that reduced funding is available to treat those people, but the commissioning arrangements mean that drug and alcohol services are commissioned by local authorities and are no longer integrated or joined up with the NHS, which makes it much harder to treat people with co-existent mental health problems; to find housing solutions, as the NHS does on a daily basis, for patients with a housing need; and to address some of the challenges we face in joining up and integrating care with the criminal justice system.

I hope the Minister will take away those challenges.

[Jonathan Ashworth]

Will the hon. Gentleman give way?

[Dr Poulter]

I will give way very briefly.

[Jonathan Ashworth]

I am grateful to the hon. Gentleman —I am sorry, Madam Deputy Speaker, but I will be very brief.

The hon. Gentleman is making an excellent speech, and I agree with every word—I hope I have not ruined his career prospects by saying that. Does he agree that the way in which services are commissioned, and the lack of integration with wider mental health services, is leading to a problem in recruiting addiction psychiatrists into the sector?