Examination of Witness (Questions 1320
TUESDAY 12 FEBRUARY 2002
1320. You have talked about the figure of £1
spent on prevention saves £3 in enforcement, can you let
us know the current split in the drugs budget between enforcement
and criminal justice and health issues?
(Mr Ainsworth) Sorry, that was treatment,
1321. Sorry. I want to know the balance between
money spent on enforcement and money spent on public health, given
the comment from Keith Hellawell when he took over in 1998, "We
spend 63 per cent of all our money on the criminal justice system",
which he thought was a bad policy.
(Mr Ainsworth) It is hard to measure
all of the money that is spent on drug-related issues. For instance,
there is a lot of expenditure by the NHS which does not fall within
the ring-fenced drug budget. There is a lot of activity by the
police and courts which is almost immeasurable but which has a
drug connection. The only thing I can measure is the pro-active
funding we are providing through the Drug Strategy, and I can
give you an indication of the movements of money over a period
of time, and I will provide the Committee with this, if you like,
afterwards. If you take the year 2000-01 and then the last year
of the current spending review, 2003-04 and the movements there
have been within that, treatment will move from 33 per cent to
40 per cent over that period of time; young people, which is mostly
education, will move from 9 per cent to 12 per cent; communities,
which is as I have said currently targeted on re-offending, will
move from 6.5 per cent to 9.5 per cent; and availability will
move from 50 per cent to 38 per cent. We have not cut the money
on availability, it is because the overall amount of money allocated
has been growing quite considerably. For instance, in 2000-01
we were spending £353 million, and it will be £380 million
in 2003-04, so the actual money has gone up although the percentage
of the overall pot has declined quite a lot as we have pushed
substantial growth on the treatment side.
1322. I think we all understand the difficulty
in calculating any of these costs and the opportunity costs of
certain decisions. When your Department gave evidence at the end
of October, we were told there was a York University Report commissioned
on the overall cost of drugs to society. Can you let us know when
that report is going to conclude? Presumably we will be able to
see the results when it does conclude.
(Mr Ainsworth) It has not been published
in total yet but we have some headline findings of the study which
are quite fascinating actually. The York Study estimates that
the economic costs, mainly to the Health Service and the criminal
justice system, of drug misuse in England and Wales are between
£3.6 billion and £6.8 billion. Adding on the social
costs, the overwhelming majority being crime and cost to victims,
increases their estimate to between £10 and £18 billion.
Problematic drug users, they say, are responsible for 99 per cent
of that cost.
1323. So that figure of 160 to 280,000 drug users
which we call problematic are responsible, potentially, for £17
billion-worth of damage to the economy. Is that right?
(Mr Ainsworth) Those are the headline
results of the York Study.
1324. That is very enlightening, thank you.
(Mr Ainsworth) Yes.
1325. Any estimate which varies between 10 and
18 billion is not that enlightening, is it? There is a lot of
(Mr Ainsworth) There are wide variations
in scoping the size of the problem.
Chairman: Finally Mr Prosser has a few questions
on harm minimisation.
1326. I would like to ask you what progress has
been made on the Action Plan on drug-related deaths and whether
you have any views on the use of safe injecting rooms and pill
testing facilities, et cetera, to bear down on the harm?
(Mr Ainsworth) We have underlined treatment
targets and SDA set a target of reducing drug-related deaths by
20 per cent, and also the universal provision of needle exchanges
and syringe exchanges in order to try to avoid sharing of equipment.
I say a lot of money has already been put towards that off the
back of HIV but there are other issues like hepatitis B and hepatitis
C, and that concerns us as well.
1327. Are you able to give us any indication
of progress to date in reaching those targets?
(Mr Ainsworth) Can I let the Committee
have a note on where we are with that?
1328. In terms of safe injecting areas and pill
testing is that something that you are considering as part of
(Mr Ainsworth) Safe injecting areas like
the Swiss experiment?
Mr Prosser: Safe injection areas where a clean
needle is provided, perhaps a safe-ish dose is provided and some
level of supervision?
1329. As in Germany.
(Mr Ainsworth) We have provided needles
to problematic drug users and syringes, and the rest of it, we
are not requiring them to stay within a particular area in order
to do so. I think we would be worried about them effectively walking
away from that provision were we to do so.
1330. We mentioned earlier hepatitis C, is it
right that drug users are excluded at the moment from having treatment
for hepatitis C?
(Mr Ainsworth) Excluded from having treatment,
in what environment?
1331. Injecting drug users are excluded at the
moment from treatment for hepatitis C, is that right?
(Mr Ainsworth) Not that I am aware of.
There is some guidance that has been issued by the Department
of Health on how to deal with hepatitis C-infected drug users,
so that does not match with the idea that we are excluding them
from treatment. Obviously if people are not stable because of
their drug habits then treatment is very difficult.
1332. Perhaps you can come back to us with some
clarification on that point as well. I am turning now to the Misuse
of Drugs Act and the changes which took place, in particular amendments
of Section 8 of the Misuse of Drugs Act. We have had some evidence
that harm minimisation treatment by agencies and individuals could
be disrupted or even stopped because of the limitations brought
in by Section 8 in terms of the use of accommodation and hostels?
(Mr Ainsworth) Yes. There is some worry
and we took representations over a period of time in order to
try to satisfy ourselves that Section 8 provisions were appropriate,
where necessary, and would not lead to people being criminalised
in an inappropriate situation. The provisions were brought in
because of very real problems that exist with crack houses. We
had a particular problem in North London around Camden and the
Kings Cross area over a period of time. If we were to give some
kind of exemption to people in any given circumstance then we
could find ourselves in a situation where facilities were being
abused and the prosecuting authorities would have no ability to
deal with the issue. We are only aware of a couple of problems,
and they arose in areas where advice was given and it was felt
that despite that inappropriate practices were continuing. As
long as people are sensible about how they use these provisions
we would be very loathe to lose them with the consequences that
could arise in terms of facilities being abused rather than used.
1333. I turn now to Section 9A, which is to do
with the pharmacists' provision of paraphernalia, as they call
it. We had evidence from pharmacists to the effect that they were
not allowed to prescribe citric acid and sterile swabs and this
caused them great difficulty giving the sort of help they wanted
to addicts with problems. Is that something that you are looking
(Mr Ainsworth) Overwhelmingly the provision
of equipment has been about syringes and needles, for obvious
reasons, because it is blood borne infections that people that
have been worried about, hepatitis B, hepatitis C and HIV. If
there is a case that can be made for the provision of other equipment
we will be happy to look at it. That has to be the main focus
of harm minimisation
1334. Could we ask you to look at the evidence
given by the pharmacists to this Committee, because they made
a very strong point on that.
(Mr Ainsworth) We are aware of the evidence
that was given and we will be receiving your report within a very
short period of time. We have no intention of ignoring any of
the recommendations without properly evaluating them.
1335. Finally, Minister, the pharmacists also
mentioned the inflexibility of the Act with regards to dispensing.
One of the examples they gave was when the prescription from the
doctor or the consultant needed to be handwritten this caused
all sorts of difficulties and there were all sorts of practical
barriers in dispensing drugs in a controlled environment across
the counter. In the same fashion as you will look at the evidence
from them perhaps you can look at those matters as well .
(Mr Ainsworth) I am happy to do that,
but I have to say that in the relatively short period of time
I have been in this job, with the opportunities I have had to
get out in the field, this is not an issue that has been raised
with me. The issue which has been raised with me of most concern
is the preparedness of GPs to become involved in providing treatment.
In any given area there are a very small percentage of GPs who
are prepared to offer cooperation with drug treatment therapies,
that is something we are far more concerned about. No one has
raised this issue, although I saw the evidence that was given
to this select committee.
1336. We had a lot of evidence from GPs and there
was a lot of contention as I recall.
(Mr Ainsworth) They were arguing with
1337. They were indeed. Let us go back to the
pharmacists, in this whole debate the pharmacists felt they were
an important player and they had been ignored. I am not saying
that is reflected in your evidence, but I get the feeling they
do need to be engaged.
(Mr Ainsworth) I have to admit that I
have not talked directly with pharmacists, it has mostly been
GPs and drug treatment centres. We will need to pick that up and
find out whether or not there is an issue. Obviously we do need
security and we do need to guard against leakage that is effectively
going to feed inappropriate drug use. There has to be that security
as well. If there are issues that pharmacists want to raise obviously
we will look at them.
1338. The witness from the Royal Pharmaceutical
Society suggested there was great frustration amongst their members
over their difficulty of communicating with ministers on this
issue and she did raise what seemed to us to be some serious points.
You might find it worth your while to have a chat with her.
(Mr Ainsworth) I am told that she has
a meeting with Hazel Blears arranged so that she can raise her
concerns with the Department of Health. I do not know when that
Chairman: That is fine, thank you.
1339. I just wondered, Minister, whether you
see any clash potentially between harm minimisation targets being
included in the drug strategy and the very clear, although difficult
to measure, target of reducing the availability of class A drugs.
If you are providing syringes and possibly shooting galleries,
or whatever, on the one hand but have a target of reducing the
availability on the other are you not asking the strategy to do
two rather contrary things?
(Mr Ainsworth) I do not think I have
said, Mr Cameron, that we are looking to provide shooting galleries.
What the Home Secretary has repeatedly said in this regard, this
is true about what he said about cannabis, and it is true of the
whole of the debate around drugs, is that we badly need a sensible
adult debate. We need to lift the level of awareness of the consequences
of drug misuse in the country and as part of reducing the size
of the problem, surely, I would have thought, that everyone would
see that you have not only got to attack supply, the profitability
of the criminal elements and disrupt the criminal gangs but you
also have to try, where it is necessary to do so, depriving them
of their market. Where there are people who are hopelessly addicted
if you can get them into treatment, if you can stabilise the situation
and pull them out of the grip of the peddlers and the traffickers
that has to be a good thing in terms of the benefit to society,
because they are not going to be paying for their habit through
crime, and they are not going to be feeding the supply chain by
providing the demand. Harm minimisation is essential from that
point of view and treatment is essential from that point of view.
It is, surely, also essential because of these very serious viral
illnesses that there are round. As I said, the main drive in this
country towards upping our gain on harm minimisation was HIV.
I would hope that everyone would want us to stay focussed on the
potential dangers of such diseases.
3 See Appendix, Ev226. Back