John Mann (Bassetlaw): I should like to thank Mr. Speaker for timetabling this debate and agreeing to my request that it should last for one and a half hours. The number of hon. Members present indicates the interest in this matter, which, in recent weeks, has been raised a number of times on the Floor of the House in discussion and questions.
Hon. Members will know that I have made a fairly detailed analysis of heroin use in my constituency, but I do not propose to go through the 300-page background document, the 150 case studies or the 39 recommendations. All that is available and I believe that a copy has been sent to all hon. Members. Anyone who wants a copy is more than welcome to have one.
I want to take the opportunity to thank those who contributed to my public inquiry, for which I received a lot of local public support. Many hundreds of people contributed personally and many thousands contributed in writing. However, when dealing with one section of the community and professionsthe health serviceI sometimes wondered whether I was looking into dental services because obtaining information was like pulling teeth. That is why I called for this debate on treatment services for heroin addicts.
Until the Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Tottenham (Mr. Lammy) appeared at 9.25 am, I did not know which Minister would respond to this debate. I chose not to inquire because I did not want to skew my comments according to whether the response was coming from a Home Office Minister or a Health Minister. The provision of drug treatment services is a major issue and is a dilemma here and throughout Europe.
Yesterday I went to GOAN where I discussed CAD and the links between CDPs and DRGs under the auspices of DATS and, in Nottinghamshire, DAATS. GOAM is not responsible for the NTA so I did not discuss CDTs, but I could discuss DDTOs and the role of the LSP and the SRP of EMDA. SORTID and HETTIS may be interested, but Framework and Hope less so. Tomorrow, I shall be at the PCT. There are two PCTs involved and mine does not commission the DAAT. NCC chairs the DAAT but BDC chairs the DRG. GPs are covered by one strategic health authority and DAAT by another. Some GPs fall under a third PCT, but, thankfully, there is only one LEA and one police force, although that has two emergency numbers and two separate control rooms. Most people in those bodies want to discuss funding streams. I am a simple man and to me a stream is running water, although if it were left to the EA and NCB in my constituency, that
In my area there are far more than I have listed. When we knew that my mother was terminally ill with cancer, we received a call and a visit from a Macmillan nurse, who dealt with the other organisations. I put it to the Minister that in drug treatment, someone fulfilling the equivalent of the Macmillan nurse's role would bring about a major breakthrough in handling the plethora of organisations involved. The fact that there is not someone like that in drug treatment has contributed to the frustration and anger that has built up in my community and others.
Let me set the scene. In my constituency most of the pits shut between the late 1980s and 1992. They provided the majority of jobs in many parts of the constituency. In some villages, every male was working, or had worked in the pits, usually from the age of 15 to 65. When the pits shut, there was nothing. There were attempts at regeneration and there still are. Some were successful and some were not. The certainty of life was removed. I accept that that certainty had some downsides in terms of aspiration. 'Pit fodder' is the term that was used in schools, and was still used when I entered the House 18 months ago and it showed how the kids in those villages were perceived by the educational establishment. However, they were certain of a job for life in the community, and it had become an increasingly well-paid job over its last 30 years. That was taken away and, as predicted in the House in 1992, there has been a rise in drug addiction, specifically heroin.
The comparison between the pit villages and the more affluent rural areas is quite stark. Less than 10 per cent. of the cases dealt with by the probation service in Retford, which is a predominately rural area, involve criminals addicted to heroin. In Worksop, that figure is 92 per cent, and accounts for two thirds of all reported crime. When I met the chief constable on Monday he agreed with me that drug addiction probably accounts for virtually all the unreported crime as well.
We do not have treatment services in my constituency; they are at a distance. The philosophy of the drugs treatment service is one of harm reduction. I will come back to that because I challenge the whole ethos of the National Treatment Agency, and the whole drugs treatment business. We know the results. I could give chapter and verse, and describe the individuals who inject into their eyeballs because they have no veins left that they can use. Women have given up their children for adoption because they cannot cope with heroin addiction. Large numbers of grandmothers are caring for children. I could go on and on. I could paint a more evocative picture of the real state of play because those examples are not isolated, but I will not do so because I do not have enough time. The vast majority of criminals in my constituency are addicts. Only a few clubbing drugs are used in my constituency; there is hardly any cocaine, or crack cocaine. The drug being used time and again, and in hundreds of cases, is heroin.
There are several things that I would like to be able to say to a Home Office Minister. I want to see drugs courts because many addicts are drugs criminals. Only one of the 150 people I met was not involved in crime. That one person had a partner who funded his addiction and had done for nine years. I want addicts to be given a choice:
Fortuitously, Professor Howard Parker of Manchester university has recently produced a new reporthe has produced many over the years. I ask for your forbearance, Madam Deputy Speaker, and that of other hon. Members, while I explore the work of Professor Parker. There is a particularly poignant and important reason for doing so. His paper in Sociology magazine, which was released, I believe, on Sunday and which I accessed yesterday, is entitled "The Normalization of 'Sensible' Recreational Drug Use". According to the references, Professor Parker started writing articles on the normalisation of drug use in 1994 and he refers to Mr. Van Vliet of the Netherlands, who wrote of the concept of the normalisation of drug use in 1990.
In a wonderful throw-away phrase explaining why he did not get all the responses that he had anticipated from the young people he had studied, Professor Parker writes that of his cohorthis evidence base"up to half" went away to university, which meant that he had some problems in getting them to respond to his survey. So by his own definition, up to half the young people he surveyed in the north-west went to university. That must play a part in the debate.
Professor Parker and others who write on the normalisation of sensible recreational drug use, talk time and time again of clubbing. Well, we do not have clubbing in my constituency. Virtually nobody goes clubbing because the clubs do not exist. It is 30 or 40 miles to the nearest one and the buses that go to the clubs in Doncaster and Nottingham are infrequent and increasingly rare.
Significant numbers of people in the mining villages and other parts of the community start by experimenting with cigarettes, alcohol and cannabis and then move on to experimenting with heroin, often realising too late that they are addicted. The vast majority move on to injecting eight times a day and their whole lifestyle is based around funding that addiction. The cycle cannot be broken without treatment. According to police estimates, if someone has a criminal income of £15,000, that translates to £70,000 or £80,000 worth of stolen goods. That is per person, per year. That means £20 million worth of stolen goods in my constituency alone. Yet treatment is still not being provided.
I want to move on to the reason why I referred to Professor Parker and made what I suppose was an attack on him. The people he studied were not the same as the people who live in my constituency, so perhaps attacking him is unfair in abstract. He studied students. However, his name was cited four times in evidence to my inquiry, so I had to find out who he was and what he stood for. His philosophy of harm reduction goes right to the core of the work of the National Treatment Agency. It is central to what is going on in drugs treatment services in my constituency and it is not acceptable.
I have taken the opportunity, and will do so again, to make comparisons with what happens abroad. Last week, I met the head of drugs co-ordination for the European Union to consider the evidence base. I am not a medical expertI do not know what forms of treatment are most effectivebut the research base says that different treatments work for different people. I, and others, have called for a menu of treatment options, but that is not available.
"Changing Habits", the Audit Commission report published in February, highlighted six weaknesses, the first of which was the difficulty of accessing drugs treatment. In my area, there are transport problems for people who want to go to Mansfield or Doncaster but have no money because they are spending it all on heroin. Indeed, the most common excuse used when tapping young people for money is, "Give me money for my bus fare or train fare." That happens all the time in my constituencyit is part of the daily intimidation of drug-free young people.
What is the role of general practitioners? There is a target stating that 30 per cent. of GPs should be trained in drugs treatment. That has not been met in my area of Nottinghamshire, and in Bassetlaw we are below the Nottinghamshire average. We need trained GPs. Some are good; some are brillianttwo of them took part in my inquiry and were happy to do sobut what about those who are bad? What sanctions are we applying to ensure that GPs have the knowledge base within their practice to deal with the problem? I want new clinics on a local base that can feed back into the National Treatment Agency.
Like me, the Audit Commission found that there were lengthy delays in treatment. That has been mentioned by other hon. Members, and I will allow them to present their own facts and figures. If I, a member of my family or any of my constituents have cancer, we should receive immediate diagnosis and treatment. I do not expect to be told to come back in six months or a year. One of the more puzzling, and prevalent, official phrases that I came across was "presenting". The addict must present himself, as if to say, "Here I am, sir: I have come to present myself because I want to come off this drug". If they do "present" themselves they are often told, "Go away sonny. Come back tomorrow and present yourself again, and again and again, to prove that you are genuine."
The parents of Mr. Y, who is from a stable family background, came to me just over a year ago. The father buys him drugs to stabilise his intake and to get him away from the criminals. He has spent more than a year trying to reduce his son's intake and has to take him to accident and emergency every time he overdoses, which is about once a month because the family are not professionals so are not managing matters properly. That is a great expense to the NHS. Those petrified parents wanted residential rehabilitation for their son. In the nine months before my inquiry, I could not find a single case of residential rehab in my constituencynot one. Amazingly, in the week after the inquiry, Mr. Y went into residential rehab. That was, of course, going to happen anyway, but I want to know on what basis decisions are being made, and who is making them. Those are real case studies.
The National Audit Office found, as I have, that assessment procedures are chaotic across the country. In some places assessments are made by a team, but in my area just one person seems to be making assessments on who should get what treatment, and there is no right of appeal.
I should like quantified statistics. What is the definition of treatment for the 118,000 people currently being treated in this countrythat is the number according to the information that has been given? I should like to know how many in my constituency are being treated because I have not been given those statistics. I asked publicly for the figures, but they were not given, even when I asked again. What quantifies success? How many are going into residential rehabilitation and why? How many are being treated in the community, and how? How are we measuring success? I want to see comparisons of success, because it can be defined in different ways. For some individuals it might be defined as reducing heroin intake and stabilising. They might not ever be drug free, but might be stable for a long period of time, out of the crime cycle and fit enough to get back into work. For othershopefully a majoritysuccess means being drug free. That quantifying is not there in anything I have been given. Perhaps the Minister can help me on that.
Such comparisons are critical, and are needed across Europe. The Council of Ministers is meeting to discuss this matter on Thursday and Friday this week, and I believe that either the Home Secretary or a Health Minister is going to the meeting. There will there be a
I should like to see the database of the Exchange on Drug Demand Reduction Activities quantified. It is rather difficult to access it. That might just be because of my internet prowess, but I have been repeatedly unable to access the EDDRA database on drug demand reduction programmes. Certainly, the EU has been concentrating on supply.
As I have said, I should like to see the equivalent of a Macmillan nurse in drug treatment servicesone person who is there to advise the families of addicts. I should like to see the notion of people having to "present" themselves for treatment knocked on the head. Treatment should just be made available.
My next comment is directed at the Home Office. I should like to see drugs courts and drug testing in the custody suites of my local police stations. Those measures have been piloted in Nottingham, and there is nothing wrong with doing things in the cities, but we want the same priority. I want to see those measures in my constituency.
More than 3,000 people have responded to my inquiry, and I have met 150 heroin addicts both on a one-to-one basis and in groups, which is a reasonable evidence base. I have written up the results and given the Department of Health and the Home Office CDs containing the case studies, in which we have masked the names to preserve confidentiality. The case studies follow a pattern, which is repeated and repeated and repeated, of low aspirations and mobility.
Young people who experiment with a range of drugs compare their control of taking cannabis with their initial control of taking heroin. That is what they said, not what I said, and they said it repeatedly. Young people who experiment with smoking heroin find themselves addicted and move on to injecting. Heroin was £5 a hit in September, but it is now £2, and one can get a free lump of crack with it, if one really wants it. Ironically, although it is free, heroin addicts are not taking it. Some addicts inject themselves eight times a day and there have been nine heroin overdoses.
Families are being torn apart, and large extended families in mining communities are being hit by crime carried out by their own family membersthere is £20 million worth of drug-related crime. My drugs action
Mr. Gary Streeter (South-West Devon): I commend the hon. Member for Bassetlaw (John Mann) for securing the debate, for the power and passion of his speech and for his commitment to the vital subject of drug addiction in our country. Although I cannot match his level of commitment in looking into the matter through his inquiry, none the less, I have started my own investigation into what I consider to be one of the most serious menaces to the coherence of our society. I strongly agree with him that one issue affecting efforts to tackle this big social problem is the incoherent approach to providing a response displayed by the Government, local government and health authorities.
I welcome my hon. Friend the Member for Billericay (Mr. Baron), whose first outing on the Front Bench this is. I am delighted that he is here, and having watched him in the Chamber on a number of occasions, I know that this will not be his last such outing. I am sure that I will be sitting behind him for many years to come.
At the beginning of this year, I decided to undertake some research into drugs and youth crime both in Plymouth, which is in my constituency, and in Vauxhall, which is the part of London in which I have my tiny accommodation. I thought that it would be good to balance two different communities in my investigation of drugs, crime and young people. I spent a number of months pottering around both places on my own, talking to local authority officials, the police, voluntary sector agenciesthey do a great job trying to tackle the problemand young people. I met some wonderful people: many of those working in the voluntary and charitable sectors trying to grapple with the problems of some of the most disturbed and troubled youngsters in this country are real heroes and an inspiration to all of us.
The one message that came out loud and clear from the police, local government and voluntary sector agencies was that when a heroin addict makes the brave decision to kick their habit, when they reach that low point in their life that I believe each of them reaches at least once, when they are so steeped in misery that they want to end their terrible addiction, there must be immediate access to help. That simply is not available at present. It is certainly not available in Plymouth, in parts of London orpicking up on what the hon. Member for Bassetlaw saidin many parts of the country.
We know that drug addiction causes acquisitive crimethe police in Plymouth tell me that 80 per cent. of burglaries and thefts are drug-related. We know the human misery that is involved. We know that heroin addiction is a family breaker. All the agencies say that it is a massive social problem, but the response to it is incoherent. Immediate access to appropriate treatment simply is not available. It is very much a matter of catching the moment at which an addict decides to kick the habit, and help must be immediate. Six months later is far too latesix days later is too late. We must catch the moment.
In Plymouth, heroin addiction is now an enormous problem, and the police tell me that crack cocaine use is well on the wayin their words, not mine, "You ain't seen nothing yet." They believe that crack cocaine use in Plymouth will put heroin addiction in the shade. On the horizon is a massive problem for many parts of the country, and I call on the Government to come to grips with it now. They must improve their responses and try to solve the problem before it drags us down.
I began my personal researches a few weeks ago. As I started to talk about the issue through sections of my local media, a gentleman came to see me in my surgery to discuss a problem with one of his family members. We had a long session together and I asked him to go away and write to me with the details. If the Committee will forgive me, I shall read out part of his letter in which sets out his experiences, as it says everything that must be said about what is happening out there and the existing responses and available treatment.
We then visited the CDS, who informed us that they could help if the addict is willing. My granddaughter categorically stated that she wants to be clean and we were then advised that the current waiting list to start a detox course is 6 months. We were further informed that the wait is due to current shortages in manpower and lack of funding. The local Harbour Centre is able to provide an instruction to GPs to prescribe the heroin alternatives, DFs and methadone. However, very few GPs are willing to do so because they don't want the addicts, with associated problems and disruptive behaviour, in their surgery. I was also told that 'Going cold turkey can and does kill addicts and is not to be entered into under any circumstances'. To my absolute amazement we were then given the only remaining option, which is apparently given to all addicts, 'Commit crime and get caught in order to fast track the system, as there is no treatment available in the short term'. Once within the legal system the Probation Officer can apply for a DTTO (Detoxification Testing and Treatment Order)."
I do not point the finger at the current Government any more than at past Governments. The problem has crept up on us in the past few years and has now become the biggest social problem that we have ever faced. We know that the cost of funding a heroin addiction can be as much as £100 to £200 a day. One remarkable manMark Williams, who works for Centrepointtold me that many of the people he was trying to help were selling their bodies at night in Soho or committing burglary to raise money for their heroin addiction.
The problem is of huge importance and access to immediate treatment is the real solution, so the Government must redirect resources and move them upstream. Let us not debate whether I am calling for taxes to be increasedas it happens, I am not, but I would if it were the only solution to this massive problem. However, there are areas from which resources can be redirected: for example, in a sitting last week of the Select Committee on the Office of the Deputy Prime Minister, we realised that there was an underspend of £350 million. That would do for starters.
There are other avenues of action. First, what about insurance companies? We all know that they are struggling at the moment, and they would make a massive saving if some of these problems were nipped in the bud. Why do we not tap them for some funding? We must move resources upstream to ensure that money is available. Secondly, the Government must call a summit with all the treatment centres, including the rehab and detox centres in the voluntary and private sectors, to ask them how best to expand their capacity to provide sufficient access to treatment.
Thirdly, more coherence in the Government response is vital, in particular by having one funding conduit. I cannot tell hon. Members whether in Plymouth primary funding comes from the local authority, from the health authority or directly from the Home Officethere is real confusion. Likewise, I did not know which Minister would respond to today's debate, but I am delighted that a Minister is here.
We need more coherent funding mechanisms. I understand that one reason why there is such a delay in getting access to treatment in London is because local authorities bounce what we could call customers off each other. For example, if someone with a family home in Croydon is caught up on the streets of Lambeth and wants to access treatment, a debate takes place between Croydon and Lambeth authorities about which of them is to pay for it. That can take months to resolve, which is no good when that young addict has made the brave decision to kick the habit. Perhaps providing a central funding agency in London should be the Government's response.
We place a statutory duty on local authorities to house homeless people, so perhaps we should place a statutory duty on them to ensure that addicts who want to kick the habit have access to treatment. Someone must take responsibility for the problem. Local authorities should not be providing treatment; in my view, they should do almost nothing but act as enabling authorities. However, in the right climate, some wonderful organisations in the voluntary and private sector could expand.
The Government face no more important a task than to put in place a coherent and immediate system to tackle the problem of drug addition. The great advantage for any Government who made progress in that field is that, within a very short time, the crime figures would plummetand the Government would get the glory.
Mr. Deputy Speaker (Sir Nicholas Winterton): Order. The matter that we are debating this morning is of immense importance, and a number of hon. Members want to speak. If they use considerable self-discipline, I might be able to call them all, but that means contributions of four minutes or less. I call the hon. Member for Rhondda (Mr. Bryant).
Mr. Chris Bryant (Rhondda): With that injunction in mind, I shall try to be concise, swift and brief. I commend my hon. Friend the Member for Bassetlaw (John Mann) not only for securing this debate, but for speaking with such eloquence on this and other occasions.
I am intrigued that a Minister from the Department of Health should be here today. I represent a Welsh constituency, and although the Minister will probably not be able to answer many of the issues that arise there because they are devolved matters, I intend to speak briefly about the scale and nature of the problem in Wales.
We have about 7,700 problematic heroin and crack cocaine users in south Wales. At least 270 young people died through the use of drugs in 2000, but we still do not have the figures for 2001. At least 28 young people in my constituency have died from drug abuse since I was elected 17 months ago. The market in heroin and crack cocaine in south Wales is worth about £130 million, so whatever resources the Government are able to throw at the problem, they will scarcely match the sums of money invested by dealers and pushersespecially those in the major markets in Liverpool, Manchester, Birmingham and Bristol, who are trying to invest in the new market that has developed in the south Wales valleys in the past five to seven years.
In November and December 2001, the vast majority of new prisoners in south Wales jails tested positive for either heroin or crack cocaine, and many of them would still have tested positive when they leftindeed, some would have tested positive on leaving prison who did not test positive on entering. Between 1993 and 2000, south Wales witnessed a 50 per cent. increase in drugs deaths, yet during that time the United Kingdom average fell by 8 per cent. However, I have a word of caution about the figures for drug-related deaths, because the coroners service has a considerable way to go before we can rely on what is counted as a drug-related death. Some coroners will count a death as drugs related only if the needle is stuck in the arm when the
In the south Wales valleysin the former mining constituenciesthe problem is slightly different. We have close-knit communities where such deaths are not anonymouseveryone in the village knows the person who died and other members of the family. That is significant, not least because it means that everyone knows where drugs are available. Everyone in the community could say where heroin or crack cocaine can be obtained. That is different from what happens in the cities.
Few GPs in south Wales know enough about drug treatment, particularly for heroin abusers, to be confident of ensuring that their patients get the right treatment. The fact that about 40 per cent. of GPs will retire in the next few years will present us with another terrible problem, because many GPs have not been in close touch with the issue throughout their working lives. Ten years ago, only one of the police cells in the Rhondda would have had a note on the door saying that the occupant had a drug problem; now, every single cell door carries such a notice.
South Wales has specific problems and I hope that Ministers or the Welsh Assembly can solve them. There has been a significant increase in the number of my constituents who go to the local community drug and alcohol team and into treatmentindeed, the number is three times greater than in surrounding constituencies. However, the team was closed to new clients four months ago. The problem is not that there is a long waiting list for people in the Rhondda, but that those responsible for providing services have overspent and have been so successful at getting people into treatment that there is no waiting list. The challenge facing Bro Taf health authority and the Welsh Assembly is how to deal with that issue. There is an enormous lack of trust between public sector and voluntary sector agencies, and one does not need to study my constituency long to notice that.
The Prison Service does a good job of weaning people off their various drug dependency problems, but many still return to the community believing that their level of tolerance is the same as when they went into prison, when in fact it is lower. That results in many of the drugs-related deaths in our constituencies. I therefore hope that the Prison Service will build stronger long-term relations with the local health service so that people can receive ongoing treatment.
Some politicians in south Wales confuse the broader issue of treating heroin abuserslet us face it, they often abuse many other substancesand the specific issues of detoxification and rehabilitation. The main issue in my constituency is how to get people into treatment; when they go into detoxification and rehabilitation is a matter for another day.
Finally, housing is an issue. For £8,000, commercial landlords in my constituency can buy a house in a terrible state of repair. They do not do it up, but they move in familiesparticularly ones with drug dependency problemswho they know will bring in housing benefit at the rate of £4,500 a year. The state is subsidising outrageous, immoral and unscrupulous behaviour on the part of commercial landlords, and the people who suffer most are the families of heroin abusers.
Dr. Brian Iddon (Bolton, South-East): I congratulate my hon. Friend the Member for Bassetlaw (John Mann) on keeping this issue alive. It is important that we endlessly discuss the misuse of drugs and, in particular, heroin, which is one of the worst social problems facing Britain today.
The number of heroin users is increasing, prices are down considerably and, tragically, there are more deaths. I subscribe to the view that we need better statistics. Coroners' certificates are completely inadequate, and I understand that the Home Office will change them shortly. The number of deaths recorded for 2000 is 1,162. That figure was given in the Official Report, 29 October 2002. I think that that is a gross underestimate, and the figure is probably at least double that. Yesterday, I discovered that there have been almost 8,000 deaths across the European Union, so this is a tragic matter.
I congratulate my hon. Friend the Member for Bassetlaw on producing his report, which I have read two or three times. I agree with much of it, but I disagree with a point made on page one, which states:
We would all like to realise that ideal, but we are living in the real world, and I do not think that we will adopt zero-tolerance policies in this country. Certain countries, such as Sweden, have adopted zero tolerance, not only towards misuse of heroin and other illicit drugs, but towards alcohol. If one tries to buy decent alcohol in Sweden, one finds that what can be bought in bars and cafés is less than 1 per cent. proof and it is almost impossible to buy the hard stuff. Therefore, I believe that we would have to adopt the same approach towards alcohol and, as my hon. Friend the Member for Bassetlaw suggested, also towards tobacco.
It is difficult to estimate the number of addicts in Britain. According to Home Office statistics, the figure is somewhere between 250,000 and 300,000, but I suspect that the true figure is higher. Before the National Treatment Agency for substance misuse was set up in April 2001, something that I very much welcomed, only
I could go on at length about the social consequences of drug misuse in my constituency, which, on all the social indicators, is deprived. In the red-light area alone, there have been three deaths in under nine months. Two young women, one of whom was pregnant and, a few days ago, a young man in my constituency, were murdered. The murders were probably all related to drugs in some waythe deaths of the two women certainly were. They were heroin addicts who were supporting their habit through street prostitution.
Because of the situation in Bolton, we have taken a hard attitude towards getting people into treatment. Political leadership is very important. Drug action teams vary throughout the country, but under Sandie Nesbitt, our very committed drug action team co-ordinator, we have one of the best DATs in the country. However, but for the fact that the chief executive of Bolton metropolitan council chairs the committee that drives the DAT forward in Bolton, it would not be so effective. If DATs are to operate effectively, they must be driven from the top, and chief executives can do that because they have the networks to be able to bring on board the health service, the probation service, the police and the voluntary agencies.
We have an estimated 2,500 drug addicts in Bolton, 84. per cent. of whom are heroin users. Almost half those known drug addictssome 1,225 are currently in treatment in Bolton. There is an increasing demand for treatment, which I am also pleased about, but the effect is that the waiting list for treatment is getting longer. As my hon. Friend the Member for Bassetlaw said, we need to aim towards a situation in which no one has to wait for treatment. There should be an open door to treatment, so that when addicts feel that they want to give up the habit, they can receive treatment immediately. Furthermore, if they relapse after initial treatment, as many addicts do, they should not have to wait to receive treatment again. In some areas, drug users have to be out of the system for six months before they can get back in. That is crazy. During that intervening gap, some addicts die because of a lack of tolerance. They start taking doses of heroin that they were formerly used to and overdose. That is a tragedy.
Unfortunately, an increasing number of under-19s in Bolton are using drugs. About 40 schoolchildren in Bolton under the age of 16 have come forward for treatment, as well as 104 16 to 19-year-olds. That also includes the figures for alcohol abuse.
One of the gaps across the country is in treatment for young people under the age of 19. Bolton is getting better at that. I want to tell people about Project 360 Degrees. It has that name because it looks all aroundin a circleand takes on board children who are desperately seeking help for substance misuse, and their parents. The project covers alcohol as well as illicit drugs and has been quite successful.
There is controversy about drugs education. It can be good, but much of it is bad. We need to train teachers. People who know what is happening on the ground have to be brought into schools. Reading passages from textbooks is not enough. When people provide drugs education they have to know about drugs, their misuse
Brighton and Hove has the worst drugs problem in Britain. I congratulate Professor Ghodse from St. George's hospital medical school, who controls the national programme on substance abuse deaths and publishes a document every six months. It is about not only drug deaths, but the worst places in Britain for drug misuse. Brighton and Hove has topped the list for several years. I urge the Minister to put more resources into places where drug use is prevalent.
There has to be a choice of treatment. If someone has been an addict for 20 years, he has to be given access to clinically pure heroin, which is diamorphine. People on that can be stabilised. The Government drugs policy debate will take place a week on Thursday on the Floor of the House. I hope that during that debate the Home Secretary will make announcements about heroin prescribing, because we need more of it.
Methadone has a role, but I am critical of how it has been used as a crime reduction drug rather than a harm minimisation drug. Other drugs should be considered. For three years, I fought with the Department of Health to get buprenorphine on board. Subutex is one of its trade names. It rather than methadone is the drug of choice in France and Australia. If it is given to fairly new heroin users, they can be helped out of addiction much better than through use of methadone. For many people, methadone is very addictive, and it has a narrow toxicity window.
A friend in Manchester is prepared to make L-methadone. Methadone has two molecules. One is toxic and the other has the desired effect. My friend wants to test L-methadone in clinics. I have put that to the Department, but it has not yet responded. I have also argued that LAAMlevo-alpha-acetylmethadolwhich is used in America, should be available for some addicts in Britain. Another choice is abstinence and 12-step programmes, for when someone wants to come off heroin but not on to methadone and is willing to accept counselling instead. Why do we not have more abstinence programmes? The answer is not methadone, methadone, methadone. The choices suggested by my hon. Friend the Member for Bassetlaw should be available to all addicts.
Mr. Deputy Speaker : I am prepared to call the hon. Member for Newport, West (Paul Flynn), but I must ask him to keep his comments short. He is an expert on the subject, but if he speaks for only two or three minutes we shall not take up any of the time allocated for Front-Bench spokesmen.
Paul Flynn (Newport, West): Things have got better. I have attended debates on this subject since 1987. As recently as 1998, there was absolute unanimity among all the speakers from the three main parties when the 10-year strategy was introduced. Everyone agreed that that was the answer, and only one voice was raised in the Chamber that suggested that it was not. Today all hon.
I received a letter from the Gwent specialist substance misuse service that said that the average waiting list for that service is 11 months, and that the longest wait is 17 months. It is disgraceful that we have arrived at that position.
I disagree with the solutions proposed by my hon. Friend the Member for Bassetlaw (John Mann), although he has done a marvellous job in bringing the subject to the attention of the House. Those solutions have already been triedwe tried zero tolerance in 1971. We once had a system that worked well, in which there were fewer than 1,000 heroin addicts, whereas the number of people addicted to heroin and cocaine in this country is now 320,000. Deprivation may be one of the factors, and those who live in poor areas are far more likely to die from their addictions, but for those who can get clean needles the figures are similar, regardless of whether they live in a deprived or a privileged area.
I have studied figures on the subject from all over Europe. Those who can get clean needles and heroin of known strength can go on for a long time. There is the famous example of the writer of "National Velvet", who took prodigious quantities of heroin all her life. She died a serene and peaceful death, in her bed, at the age of 91. The problems with heroin use stem from the situation in which people take it. Two years ago, 50 deaths were caused by one batch of contaminated heroin in Ireland and Scotland.
No one should leap to instant conclusions. Zero tolerance was the answer in America, but in this country our harshest prohibition policies mean that for every 100,000 people, we have a prison population of 130. That is one of the highest prison populations in Europeit is higher than Turkey's. In the United States, the prison population in that ratio is 700, which is partly the result of zero tolerance. The increased use of heroin is driven by the greed for profit; people make a great deal out of it, and many of the dealers are addicts and are dealing to feed their own addiction.
Dr. Evan Harris (Oxford, West and Abingdon): I understand that time is short, and I do not want to take up any of the time that the Minister and the Conservative Front-Bench spokesman need. The subject is one that Back Benchers should have time to discuss, and we all owe a debt of gratitude to the hon. Member for Bassetlaw (John Mann) for securing the debate. An hour and a half is not enough to discuss the matter, and I suspect that the time allocated on the Estimates day next Thursday will not be enough to deal with all the issues.
Rather than express a party position based on a paper that we have published, I want to take time to respond to the passion and content of the speech made by the hon. Member for Bassetlaw. It is a pity that Hansard will not reflect the passion with which he spoke, as it affected many of us here. He referred to the lack of coherence between the various agencies involved. That problem
The hon. Gentleman rightly mentioned the huge cost of the problem. That will not be settled by requesting extra funding from the taxpayer. I do not think that that is necessary even though, sadly, the hon. Member for South-West Devon (Mr. Streeter) could contemplate it. For every person treated, there would be immense savings to the criminal justice system, the health service and the victims of crime, as reflected in insurance premiums. On any judgment, any investment is self-funding and releases far more resourcesand that is quite apart from the increase in human happiness and the reduction in human misery for users, families of users and the victims of crime associated with the problem.
Many hon. Members said that there are difficulties accessing treatment. The hon. Member for Bassetlaw raised several issues. For instance, there is the question of transport. Treatment needs to be local, which is why general practice will always have a role, because that is the local, accessible service. There are issues about the quality of that treatment, particularly in general practice, and about delays, not only in terms of access, reduction programmes or acute detoxification, but in getting on to residential rehabilitation. That has been shown, at least for adult usersthe evidence is very goodto stop people from simply returning to the position from which they started, by mixing with their old friends and the dealers they know, and going to the places where they had the lifestyle of injection.
I had the privilege of spending a few hours at the surgery of a GP in my constituency who takes a special interest in the treatment of drug users. It was fascinating to see him at work. I have encouraged him to do an audit of his results. However, although he had an interest, he was never funded to do that work. He had to do it in time that he could have spent doing other work in his practice. It was difficult for him to organise the practice because of the problem of people not wanting to share waiting rooms with drug users, an issue raised by other hon. Members and certainly by patients in the practice.
There is a strong argument for additional remuneration of GPs to encourage the best to do such work, not simply those who are committed. There is an argument about the quality of service provided by some GPs offering methadone. I do not think that sanctions are required. More resources are required for training and support. In addition to a GP, a counsellor and testing arrangements are needed to ensure that the contract that is entered into is kept to.
There is the issue of prostitution by drug users. The current restrictive criminalising laws on prostitution make it difficult to provide the help and access to treatment services needed by those involved in prostitution, particularly young women.
The take-home message from the debate is that drug addiction should be seen as an issue for the Department of Health, not the Home Office. I am surprised that there was any doubt about whether a Health Minister would be answering the debate. The problem is that many people consider the issue in terms of crime. The idea that one has to commit a crime to get treatment is heinous. I am not sure that prison is necessarily the right way forward, and one is required to reach a threshold of criminality to access drug treatment and testing orders. The Government are bringing in drug abstinence orders and drug abstinence requirements, which are a lower tier. It might have been better to have done that earlier, alongside the drug treatment and testing orders. In my constituency, so desperate are magistrates to use drug treatment and testing orders that they are using them at a lower threshold, and they run out of money by at least mid-year.
We have to be careful about selective citing of the evidence base. There is now increasing evidence from overseas about the option of maintenance on heroin. We believe that the validity of clean injecting roomsoften called shooting galleriesshould be explored. I hope that the Government will not rule that out completely, as I fear they might, because it is a way in which to reduce harm and ensure adequate access to treatment.
Professor Howard Parker will be able to speak for himself, and might write to the hon. Member for Bassetlaw now that his name has been raised. However, I am not sure that talking about the normalisation of sensible recreational drug usewhatever that isis the same as showing people how to inject into their eyeballs.
We must not confuseI do not think that the hon. Member for Bassetlaw didthe decriminalisation of soft drugs with the suggestion that hard drug use is in any way sensible or could be considered recreational. It is a health problem and we need health solutions. Sometimes criminal justice solutions prevent people from accessing the most appropriate treatment.
Mr. John Baron (Billericay): I, too, congratulate the hon. Member for Bassetlaw (John Mann) on having initiated the debate and on having spoken with such passion. The effects of heroin use are devastating and it is extremely sad to hear about their terrible consequences in his constituency. Having read his inquiry report, I offer him my best wishes in his efforts to address the problem.
All hon. Members who have spoken today agree that the issue is serious and requires urgent attention. However, all discussions about the drug, this one included, are hampered by a dearth of reliable research and data. I acknowledge the hon. Gentleman's point that there are few statistics available for his constituency, but there is a wider issue: there are many gaps in our knowledge of the national problem. Professor Neil McKeganey and Dr. Gordon Hay of the centre for drug misuse research at Glasgow university have said that, nationally, we have no drug survey, no assessment for problem drug use, no reliable record of the numbers in treatment, no school survey, no estimate of drug-related crime and no data on hepatitis C prevalence.
Without reliable information and data, we cannot hope to administer the appropriate solutions. Will the Minister address the points raised by McKeganey and Hay, and tell us whether the Government intend to put right the situation with regard to the specific examples that they have given? If so, what are the expected timetables?
As a society, we must recognise the many harmful social effects of both heroin and drugs in general, of which the hon. Member for Bassetlaw spoke so passionately. They include marital breakdown, neglect and abuse of children, poverty and accidents, particularly road traffic accidents. In addition, the links between drugs and crime are widely accepted. It is estimated that the cost of hard-drug related crime is some £20 billion. The hon. Gentleman told us that some two thirds of crime in his constituency is drug related. The criminal justice system must clamp down on those who deal in drugs.
However, as has been said, simply addressing the issue as a crime problem is wrong. That is the fundamental flaw in our drugs strategy. There is a chronic and serious shortage of treatment services at every level and what services there are tend to be provided through the criminal justice system. As we heard from my hon. Friend the Member for South-West Devon (Mr. Streeter) and others, too many users are not helped until they enter the criminal justice system. Society must realise that drug use should not be simply a law and order issue, but should be addressed as a health issue.
The hon. Member for Bassetlaw agrees in his inquiry that we spend a fortune dealing with the costs of heroin-related crimepolicing and imprisonmentyet we have no coherent treatment service. The Government appear to recognise that, albeit tentatively. However, there is inconsistency between localities in the scope, accessibility and effectiveness of treatments. There is also insecurity about levels of funding, as has been highlighted by nearly all who have spoken.
The Audit Commission report, "Changing Habits" points to the uneven availability of treatment services and the long delays that users facesomething that many hon. Members have mentioned. The Home Affairs Committee's report on drugs also suggests the inadequacy of current treatment provision. There are simply too many organisations, methods of funding, bidding rounds and acronyms. That serves only to cause confusion, as the hon. Member for Bassetlaw has testified.
It appears that the Government realise that they are failing in the matters I have outlined. That is confirmed by the fact that according to paragraph 13.21 of the 10-year NHS plan the Government originally hoped to reduce the proportion of people under 25 who were using class A drugs by 25 per cent. by 2005 and 50 per cent. by 2008. That target has now been abandoned. What measures will the Government introduce to provide a seamless treatment service to get people off drugs? Such a service clearly does not exist at present.
There are too many organisations adopting too many approaches with too many different avenues of funding. That confusion needs to be dealt with by clearer communication, fewer organisations and a simpler funding stream. What are the Government going to do to put matters right, and what is the expected timetable?
The Conservative party has set out proposals to tackle the problem, and they have been put out for consultation. We have suggested that the number of drug treatment places should be expanded tenfold to be able to offer a treatment and rehabilitation place to every young heroin and cocaine addict. We believe that the current de facto policy of ignoring such users needs to be replaced, and we have suggested that each young heroin or cocaine addict should be given the choice of undergoing treatment or facing criminal proceedings. Some welcome comments have been made about that proposal. The best way of instigating the programme would be through the community and voluntary groups that are active in the relevant context. I pay tribute to the sterling work of those groups, without which things would be so much worse.
However, while a more rounded approach to the problemone that includes the health and treatment issueis important, society can also help addicts by ensuring that the law stands firm against drug dealers and pushers. The inquiry into heroin in Bassetlaw heard from heroin users who demanded longer prison sentences to help them break their habit. Many people wrote demanding stronger action by the courts, particularly for dealers.
However, the Government are causing confusion about the law. The Home Secretary announced his decision to declassify cannabis from a class B drug to a class C drug in July. He also announced his decision to increase the maximum sentence for cannabis dealers from 10 to 14 years imprisonmentthe same as for class B drugs. That incoherence in policy sends out mixed messages. That needs to be put right, starting in schools, as the hon. Member for Bolton, South-East (Dr. Iddon) explained.
Police officers certainly do not understand the policy and nor do young people. Indeed, the hon. Member for Vauxhall (Kate Hoey) believes that the reclassification of cannabis and the Brixton experiment have effectively handed drug policy and communities over to drug dealers in many areas of her constituency.
I focus on cannabis not only because it shows the incoherence of the Government's message about drugs, but because, according to the inquiry report, the issue was raised time and again by virtually every heroin user interviewed. Each heroin addict had used cannabis at an earlier stage. Heroin just seemed a natural progression. Many addicts informed the inquiry that they felt that they could control heroin use because they could control cannabis use. Those same addicts stressed the fact that the dangers of cannabis needed to be strongly restated.
How and when will the Government end the confusion? When will they send out the message that taking drugs is wrong, that it can destroy lives and that it harms society? The sooner the Government can end the confusion, the sooner lives will no longer be needlessly lost. I hope that the Minister will take the necessary steps today. Such a policy would help to free resources that could be better spent in providing treatment for heroin addictsindeed, for all drug addicts.
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy) : I congratulate my hon. Friend the Member for Bassetlaw (John Mann) on raising this important topic and on the dynamic and passionate way in which he has presented the subject.
All our constituencies are touched by the serious problems of hard drug addiction. I am the Member for Tottenham in north London, and in the past few weeks I have been working with the police on the serious problem of heroin trafficking in this country, much of which emanates from my constituency. We all see the serious problems that affect families, young children and others in our constituencies. For me, crack cocaine in London is the problem. I am the youngest Minister in the Government, and my hon. Friends the Members for Bassetlaw and for Rhondda (Mr. Bryant) will understand that hard drug addiction, and particularly the problems of crack cocaine and heroin, profoundly affect my generation. The Government are seeking to deal with that problem, which we take very seriously.
According to recent research by York university, the annual economic and social costs of drug misuse to our society are between £10.9 billion and £11.8 billion. Problematic drug users, whom the study isolates, account for 99 per cent. of those costs, which is why getting the issue right matters so much. Examination of the evidence base shows us that treatment works. It reduces drug use and its associated personal and social harms and it reduces drug-related crime. The findings from the national treatment outcome research study show that every £1 spent on treatment saves £3 of expenditure within the criminal justice system. The hon. Member for Oxford, West and Abingdon (Dr. Harris) was right to raise the associated cost of treatment and its links with the criminal justice system.
Improving treatment for drug misusers was a major element of the 10-year national drug strategy, which was launched in 1998. The strategy was comprehensive and aimed to combat drug misuse in deprived and high-crime areas. At the same time, we set up the National Treatment Agency to drive forward improvements in the quality, availability, accessibility and effectiveness of drug treatment in England.
Much of what has been said this morning relates to greater and faster provision of drug treatment services. The Government accept that, and we are doing as much as we can to deal with the problem. However, we recognise the tremendous challenge ahead of us. Very rapid expansion of drug treatment services, particularly in those areas with the worst substance misuse problems, is required to achieve the targets that we have set. The background of historic underfunding and limited capacity in that area must be borne in mind when we debate the matter.
We have made significant new funding available to address work force and quality issues in order to deliver successfully on our goals. Four years into the national drugs strategy, we have already made significant progress. Based on current performance, there is no doubt that we are delivering and are on course to reach the treatment target. I stand here today as a Minister in the Department of Health because the subject of the debate is drug treatment, and it is right that a Health Minister should respond. However, we co-ordinate closely with colleagues in the Home Office, and I will ensure that the debate is brought to the attention of the Parliamentary Under-Secretary of State for the Home Department, my hon. Friend the Member for Coventry, North-East (Mr. Ainsworth), who is responsible for drugs policy across Government.
Last night in the Library I read the comprehensive report of my hon. Friend the Member for Bassetlaw. It has also been read by the Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), who is the Minister responsible for public health. She has written to my hon. Friend and will be responding in detail shortly. We believe that increasing funding for the treatment of drug users is essential to combat drug use, to reduce crime and to make our communities safer. We have ensured that substantial extra funds have been made available for that through the drug treatment pooled budget. That budget now stands at £195.7 million, which allowed each health authority in England to receive an increase of at least 30 per cent. in April, compared to last year's allocation. However, my hon. Friend may be aware that the drug action team in north Nottinghamshire received a 42 per cent. increase in its budget during 200203. That has led to a figure for Nottinghamshire of £1.8 million, enabling the development of treatment services in Bassetlaw and the surrounding areas.
Mr. Bryant : As the Minister knows, Bassetlaw and Rhondda are both former mining constituencies. Will he commit the Department to considering the similarities between former mining constituenciesperhaps alongside his Welsh Assembly and Scottish Parliament colleaguesto see whether there are specific needs that must be met?
Mr. Lammy : In his contribution, my hon. Friend raised the issue of successful treatment, and the different measurements of success. Success means different things to people with different types of heroin addiction. It very much depends on the starting point. Success for someone with a 20-year problem will clearly be different from success for someone who has a short history of heroin use and has been able to come off the drug quickly. The number of people in treatment will depend on the starting and end points of the year, but I shall write to my hon. Friend about the specific problem.
My hon. Friend the Member for Bassetlaw referred to the drug action team, how it is made up and the contribution made by various agencies. That ensures a co-ordinated lead for the local drug strategy. It is important that it includes the police, the probation service, the health service through the PCTs and social service teams. He also referred to harm minimisation. It is vital to reduce the incidence of HIV/AIDS and hepatitis C. Harm reduction is not an add-on
When the Government came to office, they inherited an A-level system that was internationally recognised as the gold standard of school leaving and university entrance examinations. The Government inherited proposals for curriculum 2000 to broaden the A-level without losing quality. By mid-September, five and a half years later, we were in the middle of a full-blown A-level crisis; not, as so often in the past, involving allegations of grade inflation, but arbitrary grade boundary rigging to make the achievement of higher grades more difficult.
In this debate I want to unravel the causes of the crisis, to establish whether Ministers are learning lessons, to examine the activities of two specific ministerial aides in making matters worse, to examine whether Ministers made matters worse, to see whether lessons are more broadly applicable throughout the Department and Government and to discover the best way of re-establishing confidence in the A-level as the gold standard.
Curriculum 2000 was proposed by Lord Dearing in 1996 after widespread consultation. Its purpose was to broaden the A-level without losing quality. It was a means of ensuring that more students entered examinations in subjects that were not at the core of their normal activities. The former Secretary of State for Education and Skills, the right hon. Member for Birmingham, Yardley (Estelle Morris) said:
In a press release dated 15 August 2002, the Minister congratulated students and their teachers on their achievements in those examinations, but by 1 September there were reports of concern about downgrading; that is, raising the mark required to achieve a particular
I was in Birmingham with the Select Committee on Education and Skills as the story broke, and I confess that my immediate reaction was that the Select Committee ought to hold an inquiry on the subject. Wiser anddare I say itolder heads, in the shape of that of the hon. Member for Huddersfield (Mr. Sheerman), the Chairman of the Select Committee, declined to make a mountain out of a molehill. However, as we know, the then Secretary of State did not have one of those older nor, regrettably, wiser heads. Her reaction was to set up not one but two inquiries.
First, she asked Ken Boston, the new chief executive of the Qualifications and Curriculum Authority, to undertake an inquiry. The following day, she asked Mike Tomlinson, Her Majesty's former chief inspector of schools, to do so. I do not wish to badmouth the former Secretary of State, because she is an honourable and decent woman, but I believe that her reaction was one of panic. Mike Tomlinson's interim report published on 27 September said that
The fact is that different boards took different approaches to setting grade boundaries. It appears that, in OCR, those involved pull scripts out at grade boundaries and examine them. They agree the grade boundaries and then apply statistical analysis to determine whether the results match expectations. According to the uncorrected transcript of the evidence to the Select Committee, Dr. McLone, the chief executive of OCR, stated:
AQA and Edexcel, the other examination boards, approached the matter the other way around. They looked first at the statistical evidence and then at the marks and chief examiner's recommendations. The result is that one procedure is more transparent than the other; I do not believe that that has been picked up clearly enough. The OCR procedure is more transparent, and enables examiners to object to the results more easily than they might were the statistics examined before the results were put before examiners. The examiners are told where to look for boundaries whereas, under the OCR system, the examiners select and identify the boundaries and then apply the statistics. Therefore, if an examiner disagrees with the statistics, he
Tomlinson recommended that students' marked work in some A2 units be regraded and their overall GCE A-level grade adjusted if necessary. He also recommended that the QCA be asked to provide additional guidance on the standards associated with AS and A2 units, both generically and in some subjects.
That brings us to the second grading problem, which was that the relative values of the AS and A2 papers were unclear. To illustrate that point, the then Secretary of State, in response to a question that I asked on 15 Octoberon whether an AS-level is half an A-level or notsaid:
That is indeed where the difficulty lies, and the right hon. Lady could have said that again. Dr. Boston told the Select CommitteeI am quoting from an uncorrected transcript of evidencethe following:
Some points arise from the hon. Gentleman's remarks, which Ministers have still to consider. First, why did Mr. Tomlinson take no evidence from the chief examiners? Secondly, was the OCR board right to profess pleasure at the fact that only 18 of its examinations had changed, or was it benefiting from a rather narrower inquiry than Ministers had perhaps
I consider his words to be moderate. If officials are bullying and briefing the press in such a way that they are not free to report and print what they wish to, it is far more than a flawed system; it is a disgrace. The Department was rapidmore rapid than I have known it to be for some timein responding to the Committee. It denied the allegations in an unpublished memorandum. I find it hard to see why a man of such high repute as Sir William Stubbs should make such allegations if they were unsubstantiated.
Everyone, including the former Secretary of State, accepts that curriculum 2000 was introduced too rapidly. As Mike Tomlinson said, it was an accident waiting to happen. That conclusion is of wider application. Grade boundary setting could be attributed to a lack of guidance from QCA. Regrettably, the 50:50 or 60:40 split that is the relative value of AS-levels and A2-levels appears to be a fudge that has not yet been acknowledged or resolved. If there is any explanation for Dr. McLone's behaviour, it is that he was intellectually too honest to be able to cope with the
Ministers fuelled the crisis and their officials fuelled it disgracefully. The examination was introduced in a rush, and the way ahead is far from clear. We must re-establish confidence in the A-level as the internationally recognised gold standard in school leaving examinations. If we start to talk again about a new system, as the present Secretary of State did this weekend, the A-level will never regain the confidence that it enjoyed for 50 years.
Dr. John Pugh (Southport): I am sorry that my hon. Friend the Member for Harrogate and Knaresborough (Mr. Willis) is unable to be here to respond to the comments that were made about his contributions to the debate.
I approach the subject with a certain amount of background knowledge and experience. I taught A-levels for about 25 years, examined A-levels in three different subjects, designed A-level questions and dealt with A-level appeals. I recognise that some of the things that the Government are endeavouring to do are highly commendable, and that their education policy is to raise standards. They also want to maintain the integrity of a qualification that has international recognition, which I support.
The Government are also trying to encourage breadth in post-16 qualifications. A good aspect of AS-levelsa desirable one in the view of many education institutionsis that they prevent pupils at the age of 16 from considering themselves as scientists or non-scientists, as linguists or non-linguists, or as interested in, or not interested in, the arts. The narrowness of the English post-16 curriculum has been a deficiency for many years. Although A-levels have maintained a consistent standard, they have been associated with a certain narrowness.
AS-levels found a place because of the necessity to bridge the gap that emerged after the introduction of GCSEs. It was quite evident to those in schools that pupils who had done well in a subject at GCSE were not always competent to proceed to A-level straight away; they needed some form of interim assessment to gauge how well they might do at A-level. In the case of languages, pupils would often get a very good GCSE grade, only to flounder badly at A-level. The AS-level plugged that gap.
I also applaud any attempt by the Government to encourage a parity of esteem between A-level qualification and some of the higher technical and vocational qualifications. It is manifest that this country has a severe skills gap, and anything done to address that is all well and good.
Most Members in the Chamber would therefore support the Government's intentions, but their effect this year has been somewhat dire, particularly for the many students who have had to recalculate their careers and rethink the university courses that they wish to do. They have been surprised and sometimes depressed by
The introduction of AS-levels took place against a background of pupils being over-examined, and of schools being more crudely exam-driven, because of the need to figure prominently in local area league tables to attract increasing numbers of pupils. It also took place against a background of exam boards behavingI am not being unfairin a more entrepreneurial manner, whereby exams are hawked to any establishment that will take them. That is not a desirable tendency.
There is also a shortage of good examiners. Some desirable improvements have made the examination system more transparent, but they have also made examiners more reluctant to take up their task. I am referring to the system whereby pupils can retain and examine their papers, and return to the examining board with their views on how they have been marked. That is not a bad thing in itself because it leads to greater transparency, but a necessary consequence is that every examiner needs not only to put a justified mark on a paper, but to explain in considerable detail why the mark is justified. That makes additional work, which is fine if it is for additional pay. However, many quality examiners have found that such work is not compensated for, so they have decided to give up, rather than work against a background of the permanent prospect of litigation.
The Government should have been perfectly aware of that background because education institutions, teachers, parents and pupils were. The Government are therefore doubly responsible if they act rashly against a background that they themselves have ensured is rather tricky. Just like the examinee who walks into an exam without having prepared properly, they can be blamed to some extent for the outcome. Moreover, before introducing AS-levels they did not run an adequate pilot. That is a key factor, and one to which many Members will wish to draw attention. The philosophy and principles were there, but the difficulties involved in bedding down the system within a working school were not at all apparent to the Government.
In the Government's defence, it should be said that modular exams were nothing new. They had been running for many years before AS-levels were introduced, but there are differences between the AS-level in its fully-fledged form and previous modular exams. In subjects such as chemistry, it was perfectly possible to believe that a pupil could perform as well at 17 as at 18. That idea was manifest in most results for, and in most evaluations of modular exams in, such subjects. In many arts subjectsI am talking from my own experiencethere is an appreciable improvement in a pupil's maturity, ability and grasp between 17 and 18. That means that considering the type of modular
In considering specifically what went wrong with AS-levels this year, it is clear that there appears to have been some perverse statistical moderation. I do not want to enter into the details of that. As the Minister will undoubtedly tell us, statistical moderation is nothing new. It has become more sophisticated over the years. At one stage, it might have been a matter merely of setting a crude percentage rate; these days, it is something rather more considerable.
Fundamentally, there is nothing wrong with statistical moderation. One needs to guard oneself against the vagaries of exams. With the best will, and preparation, in the world, exams can still vary from year to year. They can be unduly harsh one year and more lenient the next, but the qualification should be of the same standard. Statistical moderation is also necessary to guard against the vagaries of examiners, who work within very tightly defined schedules, but who can still veer on the side of being stricter than, or more lenient than, their counterparts. There is no reason why pupils whose papers are sent to strict examiners should do worse than pupils whose papers are sent to lenient ones.
Statistical moderation is a well-understood science that is carried out by comparing across examiners, and across exams and years. Interestingly, some of that data would have been missing this year. There were no previous years to consider, so the probability of something going wrong was greater. There was nothing on which to look back, and it appears that panic set in on some boards and among some statisticians. The normal procedure of adjustment led to results that would have looked implausibly good. The examination boards clearly felt that those results could not be presented to the QCA, and that they needed some modification.
The QCA is not considered to be the simple guardian of standards. Within the educational establishment, it is widely regarded as a body with its own agenda. Despite its safeguarding watchdog role, it was initially quite happy with the results. I understand that the whistle was blown by pupils and schools who found the results downright implausible.
Dr. Pugh : I do not want to go into too much personal and anecdotal detail, but I have spoken to chief examiners and people who have had visits from the boards' statisticians, and I have seen examination prototypes go back and forth to the QCA. I can assure the hon. Gentleman thatapart from the issue of preserving standardsthe QCA has fixed views about what it wants, and can be quite prescriptive in terms of modes and types of examination, and so forth. If the hon. Gentleman has time later, I dare say that I can fill out my comments further.
All of us will agree that lessons have been learned. The Tomlinson review has taken place, and schools have drawn their own conclusions to some extent. Some schools are leading a minor stampede towards the
Mr. Graham Brady (Altrincham and Sale, West): As a fellow north-west Member of Parliament, Mr. Deputy Speaker, you will be familiar with the overriding characteristic of Southport, which is that the beach goes on and on before you reach the sea. When the hon. Member for Southport (Dr. Pugh) stood up with 70 minutes of the debate stretching out before him, I was afraid that he might be tempted to be a true physical embodiment of his constituency, so we are grateful to him for being so sparing in his comments. I shall try to follow suit, although the Minister may not be entirely grateful. However, I am sure that he has copious notes.
I pay particular tribute to my hon. Friend the Member for Isle of Wight (Mr. Turner) for raising this important subject. As he made clear, he has been pursuing the matter rigorously and doggedly in the Select Committee, which has been doing a good job in trying to find out the details of exactly what happened in this year's A-level fiasco. My hon. Friend went to some lengths to describe the picture, but his opening comments must stay in the minds of all Members. He said that the A-level inherited by the Government was the internationally renowned gold standard but that, within five years, it had moved to a state of full-blown crisis. We have become used over the years to allegations of grade inflation, but this year the more serious allegationssome of which have been provedwere that grades had been deliberately adjusted and rigged to conceal the process of grade inflation.
The introduction of the AS-level was mishandled. There were, of course, good reasons for looking at ways to expand the breadth of the sixth form curriculum, such as trying to avoid too much specialisation too early. Indeed, Governments of both parties sought to achieve that. However, since the introduction of curriculum 2000 it has become clear not only that it was badly introduced but that, in the round, it has caused more harm than good. That is because it has limited the opportunity for sixth formers to engage in extra-curricular activities in the arts, music and drama. That absurd situation was raised by my hon. Friend the Member for Mid-Worcestershire (Mr. Luff) in this Chamber a few months ago when we last debated the AS-level. He told us that his daughter had been forced to withdraw from the school play because the demands of her drama AS-level course were so great. Most sixth forms have experienced that narrowing of their students' overall experience, even if the curriculum has marginally widened.
The hon. Member for Southport alluded to the fact that that absurdity has led to students who are already heavily examined being grossly over-examined. The constant repetition of public examinations at the ages of 16, 17 and 18 does not simply put extra pressure on sixth-form students; some are able to cope well with the pressure, others less so. It also has the negative effect of squeezing teaching time out of the sixth form. In a classic two-year course to A-level, comprising six terms, one term is effectively lost to examinations. Instead of having five terms to teach up to A-level, schools now find effectively that they have only four terms. They lose a term to the AS exams and a term to A2.
The perverse effect is that students come out at the other end of the process having been taught less. Crucially, they also miss out on what has always been held to be one of the most important parts of teaching people to A-level, by which I mean the little time that it takes to make the bridge from GCSEs to A-level, where the skills required are different, more complex and harder to gain.
A huge additional burden has been added to the marking system, which has been overloaded. The difficulties of finding people to mark the exams and of ensuring that the system retains its integrity have been immense. Against that backdrop, the Opposition have called for the AS-level to be withdrawn. That leads to some continuing problems that the Government need to face about the proper allocation of marks between the two papers; where the boundary should be drawn, and whether AS papers should be graded as a smaller percentage of the marks in recognition of the fact that AS is easier than the A2 stage of the A-level process. My hon. Friend the Member for Isle of Wight spoke on that subject. It is clear that the approach taken of pretending that AS is worth 50 per cent. of an A-level has been an instrumental factor in grade inflation. That led to the problems that we have been left to tackle.
The hon. Member for Southport referred to the QCA as having its own agenda, and said that it behaved like God. I do not know whether my hon. Friend the Member for Isle of Wight will have time to take him up on his kind offer of letting him hear more of his views later. If so, I would be interested to know what information has been imparted.
Mr. Turner : I had rather hoped that the hon. Member for Southport would use the many minutes available to put his views on the record, so that we could examine them in depth later and so that everyone could share them.
Mr. Brady : My hon. Friend is right; we all hoped that the hon. Member for Southport would take advantage of that opportunity. During my brief remarks, there will be an opportunity for him to speak if he wants to intervene, and I am sure that the Minister will extend him the same courtesy. We wait with bated breath until such moment may come.
One of the main responses to this year's A-level crisis has been the suggestionsthey have come from Her Majesty's Opposition, but have been echoed by bodies throughout education, such as head teachers'
Almost everyone agrees that the system would be greatly improved if the QCA were given that independence. Does the Minister and the Department for Education and Skills agree with that? Or is the QCA the only body standing in the way of what most people feel would be a step towards transparency and independence, which would help to restore the integrity of the A-level system and restore confidence in our whole examination system? I think the Minister agrees, so I hope that, when he responds to the debate, he will announce that there was an unfortunate oversight in the Gracious Address, and that the Government had intended to introduce a Bill this Session to give the QCA that much-needed independence. I suspect that such a welcome surprise awaits us. That would be an important step towards addressing concerns about the status of the A-level system and the difficulties that we have had this year regarding the different treatment of grade boundaries.
Initial reviews have taken place and have taken us a little way forward, but there remains considerable concern and uncertainty about the marking of A-levels this year. It has been suggested that another 20,000 scripts may need to be remarked or regraded. There is evidence that some examination boardseven those that have not seen fit to regrade this year's examination papersare responding by changing their grade boundaries for next year, which implies that they accept that there is a problem. For example, the OCR is adjusting the grade boundaries for psychology for next year's exams, although this year's psychology papers were not adjusted. Many schools remain concerned about unexpectedly low grades, especially for coursework. One school was shocked to find that 14 out of 20 entrants were given a U grade for their coursework; those 14 candidates had been expected to perform well and the school could see no reason why the results were so poor.
Following the inquiry and the agreement that papers might be returned to schools, one would have thought that there would be a degree of openness and that all those concerns could be swept away. In fact, the process is causing more worry in some instances. I shall refer briefly from a letter sent from one school to Dr. McLone at the OCR. I shall not mention the school's name because I do not have its permission to raise the matter publicly. The letter stated that the second batch of A-level psychology scripts were returned to the school without the cover sheets, so it had no details of the marks awarded. Furthermore, the school was informed that the scripts bore no annotations; neither was there an accompanying report, unlike the returned scripts for other OCR subjects. All of that made it very difficult to understand why the school's candidates did so badly on the coursework element. In fact, the school was hardly any the wiser now than it was on results day.
Many schools and examination candidates remain concerned that they may not have been treated fairly. The fact that detailed information is not being provided and that papers and marks are being withheld is a cause for serious concern.
What is certain is that tens, even hundreds, of thousands of A-level students were left in torment during the summer, not knowing what their grades were worth. University admissions officers were thrown into disarray, not knowing how many students they might have to accept this or next year. It is certain that parents, employers and pupils are worried about the validity of the whole A-level exam, and that many will go on to take their exams next year not confident that the mess has been sorted out. Against that background, Ministers are saying that a form of baccalaureate might be the answer might be the answer and that we should perhaps scrap the A-level and give it up as a bad job.
There is a pressing need for action now to restore confidence in our A-level system. Ministers may be contemplating moving to a different examination system, but that will take some years. The many students who enter their A-level years before such a change takes place deserve to know that their exams will be fair and to be assured of the integrity of the examination and marking systems. I strongly endorse the suggestion by my hon. Friend the Member for Isle of Wight that speculation about the introduction of a different system is damaging the reputation of the A-level at a time when we must do everything in our power to restore confidence in it and to restore the system's integrity.
The Parliamentary Under-Secretary of State for Education and Skills (Mr. Stephen Twigg) : In the short time remaining, I shall endeavour to respond to the points raised in the debate. I join the hon. Member for Altrincham and Sale, West (Mr. Brady) in congratulating the hon. Member for Isle of Wight (Mr. Turner) on giving us the opportunity to discuss this issue, which is important for our education system, before next week's publication of the second Tomlinson report. I thank everyone who has participated in the debate and I shall do my best to respond to their points.
The main priority throughout the recent difficult events was the students who studied for and sat exams in the summer, and those who will study for and sit exams next summer and in future years. In no way do I underestimate how difficult that time was, and thousands of students up and down the country faced uncertainty. That is why it was so important that the former Secretary of State, my right hon. Friend the Member for Birmingham, Yardley (Estelle Morris), responded quickly when allegations first appeared. She responded to the concerns of head teacher associations by inviting Mike Tomlinson to conduct his two inquiries. His first report was published some time ago, and the second is due to be published next week.
Let me make it clear that one wrong result for a student is one wrong result too many, and there must be no complacency about that. It is important that we not only acknowledge and discuss this year's difficulties but that we keep a sense of perspective. I do not concur with the hon. Member for Altrincham and Sale, West when
Dr. Pugh : It is statistically certain that the number of appeals this year has been relatively small, but that is not the issue. We are concerned not about the number of appeals, but about their nature and the grounds for them.
At the instigation of the hon. Member for Mid-Worcestershire (Mr. Luff), we debated similar issues in Westminster Hall before the summer recess and before the A-level results had come out. We focused in part on the nature of the curriculum 2000 reforms and on how they would progress, and we heard demands to abolish the AS-level. Those demands have been repeated today, but they are a panic reaction to what happened over the summer. Like all hon. Members, I visit schools and colleges week in, week out to see how things are going, and I do not believe that they would welcome such a reaction. Indeed, I understand that head teacher associations, in their recent evidence to the Select Committee, strongly argued against us reacting in that way.
Mr. Twigg : Examination and testing form an important part of our secondary and primary education service. However, I accept that there is a case for considering the pattern of examinations, the balance between internal and external examination and testing, the mix between assessment and testing and the timing of testing.
Mr. Twigg : I would not argue that any examination necessarily needed to be abolished. We need to consider the mix of testing, examination and assessment available in each examination conducted throughout secondary education, from key stage 3 through GCSEs to A-levels.
I agree with the hon. Member for Isle of Wight and others that we should reaffirm the principle that the A-level is a gold standard. After this summer's difficulties, our first response must be to reaffirm that point. With a new system in place, we need a period of stability. The broader debate about the 14 to 19 curriculum and the qualifications available in that age range involves a wide range of organisations, including many young people. We shall publish our proposals in the new year, as we develop the Green Paper.
The hon. Member for Southport referred to the long-standing debate about how to achieve a greater parity of esteem between academic qualifications and subjects and those of a more technical or vocational character. It is clear that the matter needs to be addressed urgently, in terms not only of economics but of providing real opportunities for all young people. That is reflected in the positive response given to our Green Paper for the 14 to 19 age range.
We need to get the balance right. As the hon. Member for Isle of Wight said, we need a period of stability. We have a new system, and we do not want the gold standard of the A-level to be undermined. However, we must also recognise the reasons for introducing the AS-level in the first place. It has undoubtedly broadened the curriculum at 16 and 17, which has been widely welcomed. When I visit sixth forms in secondary schools or further education colleges, I make a point of asking people what they think about the AS-level. Sometimes they complain about the constraints on extra-curricular activity; it would be daft for me to deny that that was an issue. More frequently, however, the young people who sit the examinations welcome the fact that they are studying four rather than three subjects in the lower sixth. I have spoken to several A2 students, in the upper sixth, who say that they have ended up doing three different subjects at that stage from those they would have chosen when they were 16 because of the extra year of experience.
It would be foolish of me to deny that there are downsides and pressures, but the new system overall has some great strengths and has done more good than harm. We must learn from the difficulties of the summer, but I support the changes introduced as a result of curriculum 2000. During Mike Tomlinson's initial inquiry, he found widespread support for those principles. After only the first year of the new A2 examinations, it is far too early to consider abolishing them. We must make a success of them by learning the lessons of this summer.
Mike Tomlinson's initial inquiry made several recommendations, providing a clear way forward for re-establishing confidence in the A-level system. Everyone who has spoken today has said that that was what they wanted to achieve. The Government immediately accepted all Mr. Tomlinson's recommendations, and we suggested that the QCA take them up as a matter of urgency. The authority is doing that under the leadership of Ken Boston and Tony Greener.
Following Mike Tomlinson's initial inquiry, the QCA has worked with the examination boards, the regulatory authorities and head teacher associations to prepare a clear description of the relationship between the AS and A2 parts of the A-level courses and the standards of the resulting qualifications. Distinct versions will be prepared for practitioners in schools, colleges and higher education as well as for a wider audience including parents, students and employers.
Grade boundaries were, as has been said, central to the problems this year. The QCA has been working with subject specialists across the examination boards to prepare reference collections of exemplar material representative of the A-B and E-U grade boundaries, which are set on the basis of examiner judgment for both AS and A2 qualifications. QCA is also producing performance descriptions reflecting the characteristics of candidates' work at the two grade boundaries. Next year, for the first time, examination boards will have the benefit of archive scripts for A2 units, which will be of assistance. Tomlinson recommended revisions to the code of practice governing the key elements of assessment and award for AS and A2 exams. The QCA is now working on the revisions, paying particular attention to the section that governs the setting of grade boundaries, including the contributions of awarding panels, subject specialists and the accountable officer of the particular examination board.
We understand that the exam boards have assured the QCA that they have arrangements in place to train their examiners in the use of the revised code of practice and exemplar materials in time for the next set of examinations in January 2003. Early next year, in preparation for the summer exams, there will be extensive training, for both teachers and examiners. We are confident that those actions will prevent the repetition in 2003 of this summer's problems. Next week, Mike Tomlinson will report on the second stage of his inquiry, in which he has reviewed the operational pressures on the A-level system. We shall carefully
At the beginning of his speech, the hon. Member for Isle of Wight mentioned transparency and the operation of the QCA code of practice. The second Tomlinson report, which will come out next week, will look at the procedures that the hon. Gentleman described and make recommendations on how the current system can be improved further to guarantee standards and consistency.
Why did this year's problems happen? Mike Tomlinson concluded that they were created by the perceived pressure on exam boards from the QCA, the lack of guidance on the level of attainment expected for a particular grade in an individual paper and the lack of common understanding about the standard required to ensure that the overall A-level standard was maintained. Although responsibility for standards rests firmly with the QCAwe are pleased to see its new leadership taking forward Mike Tomlinson's recommendations on clarifying A-level standardsthe Government are clearly responsible for addressing the broader policy issues, many of which have come up in today's debate.
Dr. Pugh : I should be interested in the Minister's views on the little sideshow debate on the QCA. My view is that the QCA has pursued its own agenda. The hon. Member for Altrincham and Sale, West (Mr. Brady) wants it to be independent, which implies that it was pursuing a ministerial agenda. What is the Minister's view of the QCA?
Mr. Twigg : The hon. Gentleman will have to wait for a moment because I intend to address that point and a related point made by the Opposition spokesman, the hon. Member for Altrincham and Sale, West.
The hon. Member for Altrincham and Sale, West has also raised specific concerns about psychology. The regrading exercise highlighted specific issues concerning syllabus design and assessment and marking schemes that the OCR was using for psychology. We have asked the QCA to look into that issue to make sure that the OCR takes effective action quickly to address it before next year's exams in January and July.
Mr. Brady : Does the Minister agree that in the interests of transparency it is essential that the cover page and the annotated scripts should be available to schools when examination papers are returned to them?
The hon. Members for Southport and for Altrincham and Sale, West raised the question of young people in education today being over-tested, and the hon. Member for Southport connected that to the publication of performance tables. I am acutely aware of
The concerns set out by the hon. Member for Southport came up frequently at those conferences. My Department faces the challenge of looking at how we can balance the proper desire of parents and students to know about schools' performance with the immeasurable outcomes, which can make a real difference for young people, that schools deliver. That point is serious. When I meet employers and employers' organisationsI am sure that other hon. Members will have experienced thisone of their most frequent concerns about young people leaving school and applying for work is weakness in the field of "soft skills"; that is a terrible phrase but we all know what it means. Interpersonal and communication skills are important in achieving success today. They are not necessarily measured by performance tables, and I should like us to debate how we can more effectively encapsulate how successful a school is in making a difference to immeasurable, so-called soft skills, which matter to young people.
The abolition of performance tables is neither viable nor desirable, but the provision of a wider context in which to place informationfor example, via value-added measuresand an ability to describe some of the other things that schools do that make a difference to the abilities and outcomes of young people is worth considering. I hope that we can take that forward, and I look forward to hearing the contributions to that debate.
Dr. Pugh : I value the Minister's encouraging noises. What he is saying is totally appropriate. However, when considering what is measurable, there may be a tendency with league tables for students to be entered for examinations that may reflect well on the school and provide a good profile for it. Students may be discouraged from entering exams that are worthwhile but in which it is difficult to attain the highest grades. They may be entered for exams that are of less value in career terms, but in which they are likely to achieve good grades. There is concern that schools may hunt grades per se, instead of putting the needs of pupils first.
Mr. Twigg : I am aware of that concern, but not of how widespread the practice is. I accept that it has been alleged in some cases, but we should tread with care on such allegations. It is vital that young people are entered for the examinations they want to take and are capable of studying for. We must send that message firmly to schools and colleges throughout the country.
The hon. Member for Isle of Wight referred in his opening speech to the destruction of examination papers. That is a matter directly for the examination boards and the QCA, but I can reaffirm what the Secretary of State said during the debate on the Queen's Speech; that, in the light of the Tomlinson inquiry, the planned destruction of A-level scripts has not gone ahead and there will be no such destruction before January 2003. I hope that that provides some reassurance for the hon. Gentleman.
The hon. Member for Southport referred to the burden on examiners, which is serious and heavy. There has been a significant increase in the number of external examinations for which people are studying and we need to consider the matter. I addressed part of the issue in a direct exchange with the hon. Member for Altrincham and Sale, West about the balance between internal and external assessment. Teachers have always undertaken assessments, and we all remember regular testing from our school days. The modular assessment that typifies A-levels now is that it enables students to obtain an early understanding of how effective their learning has been and to identify areas for improvement enabling them to make firm decisions about their studies. As we take the discussion forward in the light of experience this year and publication of the second Tomlinson report next week, that is one aspect that must be considered.
The hon. Member for Altrincham and Sale, West raised the question of the QCA's independence. I am not entirely clear whether that would have made a difference. Ken Boston said that he believes that the QCA does act independently and that neither he nor Mike Tomlinsonnor anyone elsehas seen any evidence of political interference or pressure on the QCA, so I do not believe that it would have made a difference to recent events. Nevertheless, we are open to that debate and we have asked Mike Tomlinson to consider the matter carefully in the next stage of his review. The key principle for the Government is that the exam system matches public expectations of integrity, fairness, objectivity and consistency.
Mr. Twigg : I am aware of Dr. Boston's comments and I have said that we are open to the debate. The hon. Gentleman is tempting me to go further, as did the hon. Member for Southport earlier, but I would go beyond my remit if I did. However, I reiterate for the record that we are open to debate and consider that matter to be an important part of the way forward so that we can guarantee the continued integrity of the A-level and learn the lessons from this year's experience.
I again thank the three hon. Members from Opposition parties who contributed to this debate. It has provided an important opportunity to review the events of the past few months and for the House to learn lessons about those events. I look forward, as I am sure do hon. Members on both sides of the House, to the publication of the second Tomlinson report next week. It will provide an important foundation for taking the debate forward.