Drugs Bill

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Standing Committee F

Thursday 3 February 2005

The Committee consisted of the following Members:

Chairman: Chairmen: Mr. Roger Gale, †Mr. Eric Illsley

†Bellingham, Mr. Henry (North-West Norfolk) (Con)

†Blunt, Mr. Crispin (Reigate) (Con)

†Carmichael, Mr. Alistair (Orkney and Shetland) (LD)

†Clapham, Mr. Michael (Barnsley, West and Penistone) (Lab)

†Flint, Caroline (Parliamentary Under-Secretary of State for the Home Department)

†Gillan, Mrs. Cheryl (Chesham and Amersham) (Con)

†Harris, Mr. Tom (Glasgow, Cathcart) (Lab)

†Heppell, Mr. John (Lord Commissioner of Her Majesty's Treasury)

†Iddon, Dr. Brian (Bolton, South-East) (Lab)

†Joyce, Mr. Eric (Falkirk, West) (Lab)

†Mann, John (Bassetlaw) (Lab)

Oaten, Mr. Mark (Winchester) (LD)

†Pope, Mr. Greg (Hyndburn) (Lab)

†Taylor, Ms Dari (Stockton, South) (Lab)

Todd, Mr. Mark (South Derbyshire) (Lab)

†Watkinson, Angela (Upminster) (Con)

Miss Sian Jones, Committee Clerk

† attended the Committee

(Morning)

[Mr. Illsley in the Chair]

Drugs Bill

Clause 9

Initial assessment following testing for presence of class A drugs

9.10 am

John Mann (Bassetlaw) (Lab): I beg to move amendment No. 20, in clause 9, page 11, line 14, after 'person', insert

', who may be his GP,'.

The Chairman: With this it will be convenient to discuss the following amendments:

No. 21, in clause 10, page 12, line 17, after 'a', insert 'GP or other'.

No. 22, in clause 10, page 12, line 26, after 'assessor', insert 'and his GP'.

John Mann: The amendments are intended to probe the Government's approach to assessment. In my view, the greatest weakness in the British drugs strategy is the person who undertakes the assessment. In reality, it is done by a range of people. As a result, the word ''script'' has taken on a new meaning; the addicts in my area repeatedly talk about getting a script. By that, they mean that someone who is not a medical professional makes a judgment on their treatment; that person then goes to a professional; and the professional comes in for a short time and writes the script. Those professionals are doctors.

I put it to the Minister that, in my area and everywhere else in the country, those professionals are the doctors who, shall we say, do not succeed when applying for jobs in general practice. The problem with that, which I have witnessed on many occasions, is that probation officers or drugs workers with no medical background—they may well come to the job with no training; perhaps they are psychiatry students or former drug addicts—operate under the generic term ''drugs worker'', which has no specific qualifications attached to it, and then presume to make decisions on treatment.

Those decisions are often wrong. The average dosage of methadone given in Nottinghamshire until nine months ago—it was comparable to that given in most of the country—was about 25 mg. That dosage does not work for most people, so they continue taking heroin on top of the methadone. It is hardly surprising, therefore, that they keep in contact with the criminal community and have a criminal lifestyle.

The way to break that cycle is straightforward. It is to have the person's own general practitioner overseeing the treatment. That happens in 90 per cent. of cases in my constituency, and the results are
 
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phenomenal in terms of non-recidivism, reduction in crime, people returning to work and people remaining in treatment. We have moved from having two people under GP treatment to more than 320. The drop-out rate over the past 18 months is so small that it is possible to calculate it exactly. It is either five or six, depending on one's definition of dropping out.

Mr. Michael Clapham (Barnsley, West and Penistone) (Lab): Will my hon. Friend give way on that point?

John Mann: I shall.

Mr. Clapham: What support services are available to GPs to help keep people on the straight and narrow?

John Mann: I come to that precise point; it is the key, and we have used it over the past 18 months in Bassetlaw with great success. First, the primary care trust has taken responsibility for drugs treatment. Secondly, rather than the GP and the medical generalist or specialist acting as support to the drugs worker, the drugs worker acts as support to the GP. That is exactly how all other chronic relapsing diseases are treated in the community. The GP may call in mental health specialists, drugs workers or housing officers, but the GP is responsible for overseeing the treatment.

Dr. Brian Iddon (Bolton, South-East) (Lab): It sounds as if my hon. Friend proposes returning to the pre-1971 British system. Am I correct?

John Mann: It is as near to that as would make no difference. I should point out, however, that treatment methodologies are far more sophisticated these days. One could describe what I am talking about as the previous British system, but one could also describe it as the Australian, the New Zealand, the Swedish or the French system, because that is what it is. It is the GP who makes the decision on treatment, in co-operation with other agencies where necessary. Probation officers, drugs workers and mental health specialists will therefore have an input, but the GP will make the decision and have the responsibility.

This approach has one other fundamental impact, which relates to the definitions of rehabilitation, and it is vital. Residential rehabilitation is one of the options available to GPs and their patients, and they can use either cognitive behavioural therapy on a day basis, which is non-residential, or something similar on a residential basis. However, for people who have been on drugs—who have, almost invariably, led a life of crime—the first form of rehabilitation is the ability to walk into their own GP practice. When we move from one part of the country to another, what is the first thing that we do when we engage with our new community? We register with a GP. The non-connection with one's GP is a key issue in non-rehabilitation; once we turn that situation round, we can rehabilitate people and address all the other health-care issues, which is precisely why drop-out rates are so incredibly low.
 
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Mrs. Gillan: As I indicated to the hon. Gentleman before we came into the Committee, I have great sympathy with the amendments, and I am listening carefully to determine whether my hon. Friends and I can support him. However, does he agree that it is also important to recognise the medical profession dimension, because many of the individuals to whom we talk have complex make-ups? We are not necessarily talking about people who will display their full medical history to an ordinary assessor, although it would be available to a GP. It is almost essential that there is a medical profession dimension, because such individuals may have many other problems, which the GP will be treating.

John Mann: Some of these people have only one problem, which can be dealt with straightforwardly; others have complex problems, which will require ongoing, detailed work involving a range of specialists. However, it is the ability to go not simply to a GP, but to one's own local doctor's surgery, that is critical to improving not only people's health, but their mental health. That is the critical point; that is my definition of rehabilitation.

That approach is proven. In one area of my constituency, Worksop, there are 9,000 people who come not under the Mansfield District primary care trust, rather than the Bassetlaw trust. Mansfield uses the British system—the new one, not the previous one—and people there who have exactly the same problem, but who live 10 miles away, routinely see a drugs worker, rather than a GP. The drugs worker will make a decision on treatment, and a distant GP, who is no longer in general practice, will come and write a script. Those involved do not even see the GP; the script is written at a distance, based on the drugs workers' recommendations.

I am challenging that approach, because it is unethical and, I would suggest, illegal, although it is absolutely main stream in the drugs system in Nottinghamshire, and elsewhere. Someone will write a script for a person who they do not know, based on the recommendation of a drugs worker. I have met drugs workers and probation officers who are proud to tell me that they know what they are talking about; they tell me face to face that they know what to prescribe. Well, first of all, they do not; secondly, they have no insurance liability for what they are doing, and neither do the people above them; thirdly, their decisions, in my experience, are normally wrong; fourthly, it is not simply a matter of pumping people up with methadone or buprenorphine, or of using a naltrexone implant, and hoping for the best. We cannot just stick people on a detox and hope that they come through that, or put them in residential rehab and hope that everything works out all right.

All those measures are modalities that a general practitioner can use; each of them may well be appropriate, but they may often change during a course of treatment that could last years or a lifetime. Being within the general practice system, and going to one's own doctor, gives an accountability and a democracy to the system, and it fundamentally works
 
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because it means that people address their other health needs. The GP can act as the factor that fires those people to get back into work.

Dr. Iddon: Is not one of the problems the fact that many GPs are afraid of prescribing in this area because they have not been trained in it, either before or after they graduated? Is not there a need for proper training? A second problem is that many people are given such low doses of methadone that it does not give them the buzz that they have been getting on the street, so they return to the street to top up with heroin. Low doses of methadone are given because it can be a dangerous drug at the higher doses that are so necessary for some drug addicts. I come back to the original point: training on dose levels is extremely important.

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Prepared 3 February 2005