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2.50 pm
The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns): I am grateful to the hon. Member for Southwark and Bermondsey (Mr. Hughes) for raising this important issue and I pay tribute to the constructive, thoughtful and thought-provoking way in which he has dealt with a very sensitive subject.
The Government's record on the provision of alcohol services is a good one and I am pleased to have the opportunity to comment on it, to mention some work that we have in hand to assist the provision of an even more effective alcohol service, and to address several of the hon. Gentleman's points.
First, I add my own tribute to the hard work and dedication of the staff of the Alcohol Recovery Project. We are well aware of the good work that they do--indeed, we currently fund from our drugs and alcohol specific grant two projects run by the ARP.
Some of the issues that the hon. Gentleman raised about alcohol service provision in London were summarised in the King's Fund London commission report on mental health, which was published last week and to which the hon. Gentleman referred. That report made a number of recommendations about substance misuse service provision generally which we are studying very carefully. However, many of the issues that the report raised were also examined during our review of effectiveness of treatment services for drug misusers which we published in May 1996. The recommendations in the King's Fund report are similar to those in the effectiveness review and we are still considering how best to implement many of the 80 or so recommendations that it made. Although the review dealt with drug services, there are many themes in it which might also be relevant to alcohol services.
We are aware that one of the biggest concerns in the alcohol field is that the support for provision of alcohol services has not had the kind of strategic attention from the centre that has been given to drugs since the publication of the White Paper, "Tackling Drugs Together," and more especially since the publication of
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We have been considering in the Department what further support we might provide for statutory purchasers of alcohol services, in the light of the warm welcome that our drug effectiveness review and purchasing guidance received. Department of Health officials consulted representative purchasers both from local authorities and from health authorities on such issues and received a number of representations which we took very seriously indeed. We are particularly concerned to ensure that the emphasis on drugs is not interpreted as giving reduced priority to alcohol--a point that the hon. Gentleman made which I would wholeheartedly endorse.
Therefore, as I announced in my speech to Alcohol Concern's annual conference in November last year, we shall be issuing draft guidance in the summer on alcohol service purchasing so that purchasers of such services can use it in drawing up their purchasing plans for 1998-99. We aim to produce a document covering similar ground to the drugs guidelines and intend that it should cover effective purchasing, the range of service options, possible performance indicators and recommendations about local co-ordination, although its eventual shape will depend very much on the views of a working group that we shall be putting together to prepare the final draft.
The production of the guidance will be in two phases. The first stage will be to draw together existing evidence and knowledge on types of service provision and their relative effectiveness and to prepare a draft review document by the end of April to enable the second phase to begin--the preparation of practical guidance for purchasers by a small working group of representatives from the alcohol field. The review document from the first phase of work will be published alongside the draft purchasing guidance. Through the first phase of work, we hope to be able to address an issue that has received much debate in the field: which types and combinations of treatment are most effective.
There has been criticism--although not so justified as I suspect that some people who make that criticism would claim--about apparent lack of provision for in-patient and residential detoxification. Research studies summarised in a 1994 publication by the Centre for Research on Drugs and Health Behaviour failed to show any overall advantage of in-patient or residential treatment over out-patient or community settings. However, this is one of the issues that our review will address and I would not wish to prejudge that review by pronouncing in favour of a particular regime. Different patients have different needs and we are keen to ensure that treatment is effective and addresses those needs.
In our review, we shall consider the whole question of effective co-ordination between various bodies. We are anxious that organisations in the health and social care fields working for health authorities and local authorities, and the voluntary sector work together as effectively as possible to provide the best possible service for patients in need. We want to consider not only different types of treatment but the possible desirability of a city-wide or pan-London approach to services, and other issues relating to alcohol services generally. We shall gather together evidence such as that produced by the King's
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That is all for the near feature. For the present, there are still several areas in which alcohol service co-ordination is actively being improved. The hon. Member for Southwark and Bermondsey mentioned drug action teams, which we established following the publication of "Tackling Drugs Together". We made it clear in the White Paper that drug action teams have the option of looking at prevention and treatment issues more generally by bringing other forms of substance misuse, including alcohol misuse, within their remit.
The widening of the DATs' terms of reference to include alcohol--where they choose to do so--can bring local alcohol services within the remit of a body with a much higher profile than before. It represents a valuable opportunity to ensure that all concerned work more closely together to develop and provide services. We regard such local partnerships as a vital key to tackling substance misuse problems effectively. Our latest reports show that more than a quarter of DATs nationally have decided to do that, and several other teams are reviewing their position. We are encouraged by such developments, and I hope that that reassures the hon. Gentleman.
We are aware, however, that the DAT model for alcohol services is not the only one. Where other local arrangements exist which address the problems just as well, there is clearly no reason to disrupt them, although we would wish them to co-ordinate their activities with local DATs in areas of shared interest, such as the provision of services for young people. Where such arrangements are not yet in place, and where the DAT is clearly preoccupied with issues surrounding illegal drugs, we would expect purchasing authorities to consider what else can be done to develop better, more co-ordinated standards of provision for alcohol services. Overall, our priority is a high standard of service provision, no matter what the exact arrangements are for delivering it. That is what we shall seek from our purchasing guidance.
As the hon. Member for Southwark and Bermondsey will fully recognise, the voluntary sector has a crucial part to play. Support for developments in voluntary sector service provision is considered by the Government to be equally important as part of our national policy. One way in which we have helped to stimulate local initiatives is through the Department of Health's drugs and alcohol specific grant. Since 1991-92, the Department of Health has grant-aided more than 100 drug and alcohol projects, giving out about £13.2 million, and we are making available a further £2.5 million for the next financial year.
The grant has enabled us to encourage new forms of service development. For next year, we have identified a single national priority in response to valuable feedback from the field. We are giving priority to projects supported by local authorities providing services for the homeless with drug and alcohol problems, in areas currently designated by the Department of the Environment either as rough sleepers initiative zones or else as zones eligible for funding from the rough sleepers revenue fund. We have £1.65 million available for new
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While we accept that services for alcohol misusers are under pressure, especially in London, developments in alcohol services since the introduction of community care have made considerable strides. Obviously, we cannot be complacent, but it seems to me that much of what needs to be done is a matter of fine tuning rather than wholesale reform and the upheavals that that causes.
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