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John Mann: My hon. Friend is right that training is important, and he emphasises my point that a competent medical practitioner should be making these decisions, not an amateur. It is amateurs who are, in reality, making the decisions. My evidence for that comes from what I have seen and heard. Probation officers and drugs workers, who I could name, have told me that they make these decisions. They are not competent or qualified, and the decisions are wrong. They under-prescribe methadone to be safe and often fail to use alternatives such as buprenorphine. That is a problem. Building GPs into the system is fundamental to the success of the Government's drug strategy.
Mrs. Gillan: The hon. Member for Bassetlaw (John Mann) has done some detailed work on drugs in his constituency, which is to be commended. He has put much thought into the three amendments, which would have the effect of involving the object of the treatment with his or her own GP. I have sympathy with what he has said.
The hon. Member for Bolton, South-East (Dr. Iddon) took the words out of my mouth; one problem with the amendment relates to cost. On the point about GPs' training on drugs treatment and provision not being sufficient, it is certainly not standard throughout the country. People are trained to different levels. The amendment would involve extra resources and training throughout the health service. It would seem that every GP's practice would need to have someone with a greater level of expertise than is to be found currently.
Dr. Iddon: Is not any treatment much cheaper than the cost to society of having a serious drug addict stealing property to top up his or her addiction?
Mrs. Gillan: We are of one mind. When the Minister turns the amendment down, her problem with it will be the immediate cost, but we should be looking ahead and thinking of the long-term saving in terms of the cost to society. There is no doubt about it: failure to treat young people—failure to treat any drug addict—results in tremendous on-costs. We will come to that later, when we discuss other clauses. One of the new clauses that I have tabled is a device to bring up that subject.
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Given that there is cross-party agreement, I hope that the Minister will listen very carefully. There is no doubt about it: despite the best efforts of agencies and Government, the statistics show that people are not completing their drug-treatment courses in large numbers. Drop-out rates for young people are markedly part of the picture and they tend to drop out of treatment within six months. They are more likely to drop out than older clients. Men are one-and-a-half times more likely to drop out of treatment than women, and those with no previous experience of treatment are 1.7 times more likely to do so than those who have been in treatment before.
The evidence that has been produced by the National Treatment Agency shows that treatment programmes are not being entirely successful. The involvement of the GP will help to put the emphasis on the fact that we seek successful rehabilitation and not just the cheap statistics of people going into drug treatment, which seems to be how we measure success. There is no doubt that more people are undertaking drug-treatment programmes, and I commend that, because the more people who start them, the more people—we hope—will finish them.
The test for the programmes is on people entering, sustaining and coming through the other end of them. There will be an increased likelihood of more cost savings, if we are to consider the matter in hard-nosed financial terms, more rewarding outcomes for the individuals and a much lesser cost to society. Therefore, I support the amendments tabled by the hon. Member for Bassetlaw. I hope that the Minister will take them on board and accept amendments from her own side, in the vein that she has exhibited earlier in the passage of the Bill.
Angela Watkinson: I support the amendment. It is eminently sensible. It is ideal if the drug user is treated by their own GP, but there is one caveat. There might be GPs who are reluctant to be involved in the general area of drug treatment. It is important that other people are willing to do it. Some GPs are reluctant to have drug users coming to their surgeries, where their behaviour might be disruptive. The inclusion of this provision is an additional option in the range of people who might be able to perform the service, albeit the ideal one, and, with the caveat I mentioned, I support the amendment.
Mr. Henry Bellingham (North-West Norfolk) (Con): I certainly support the amendment. It has been pointed out that there could be unnecessary extra cost implied in it, but we should consider the wording presented by the hon. Member for Bassetlaw. He is saying not that a GP has to be the person who undertakes the assessment, but that they could be. The provision leaves that open and provides that extra option. I think that I am correct in that conclusion. It builds in flexibility, which I support.
On the availability of GPs, we want more GPs becoming involved in the treatment and the rehabilitation of drug addicts and drug offenders. My
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concern relates to the number of GPs who have been struck off. I know that I am moving into other territory, but I hope that the Minister will bear in mind the serious problems that are being faced in the profession and the signal that has been sent to GPs as a consequence of the suspension of a number of doctors, including what happened to Dr. Adrian Garfoot. There is a batch of other doctors who have been struck off. That has sent a signal to GPs that this is a difficult area in which to become involved. That background will make the amendment more difficult in practice, but I support it.
9.30 am
The Parliamentary Under-Secretary of State for the Home Department (Caroline Flint): I shall clarify the matter. We are talking about someone who has just been tested for class A drugs. Should that prove positive, they will see an assessor at the police custody suite. We are talking about that person. If the Bill is enacted we will not only have drug tests on arrest, but a mandatory assessment. Straight away, or as soon as possible, after that test, usually in one of the custody suites in the police station, someone will meet and engage with that person about their drug-taking behaviour. The point of that is to strike while the iron is hot. Such people are there primarily to engage with the person. They might have a background in drug support and counselling, but more than anything else we want them to motivate the person to listen. Their job will be to engage with the person and tell them what is on offer, such as prescribing, immediate access to a general practitioner or a hospital, or identifying whether the person has other problems in his life.
Mrs. Gillan: Will the hon. Lady give way?
Caroline Flint: No, I wish to continue making my point because it is crucial to our discussions on the amendments.
They will need to find out whether the person has a home or is living on the streets, and whether they have dependants. They will need to discover whether anyone else in the house takes drugs, whether the person has a job and is committing crimes at the same time, and what other issues in the person's life need attention. If an appointment is required, they will need to know where he lives, and how easy it will be for the person to keep the appointment with a medical practitioner to undertake a full medical assessment of his needs and receive the right treatment along with everything else.
I do not support the amendment tabled by my hon. Friend the Member for Bassetlaw because we are not talking about the person who will decide the level of dosage for the individual. I agree with some of the points made by my hon. Friend the Member for Bolton, South-East, but, to pick up on the argument of my hon. Friend the Member for Bassetlaw, I shall refer to one of the issues that concerned me greatly when I came into my job and which is pertinent to the other discussions about the GP's position. Unfortunately, not all GPs are champing at the bit to deal with drug addicts in their community. That is sad because
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people, no matter what their health problem, deserve a health service. Yes, it should be provided in hospitals, but it should also be provided in the community. No massed ranks of GPs are lining up to deal with such matters, and some have good reasons for that. They are worried about being isolated and not having the necessary back up and support, or about how they would provide possible substitutes for people in a busy, crowded practice and, thus, how the physical dimensions of the practice would operate.
Mrs. Gillan rose—
Caroline Flint: I want to continue my point, after which I shall take interventions. We can do something about people with legitimate concerns, but let us consider the community outlined by my hon. Friend the Member for Bassetlaw in which one GP practice was working alongside a drug action team and others. I refer to the position in which there is shared care with a multi-agency group and others, who have conferences with the person responsible for housing matters and which is pivotal to clinical and medical interventions and the provision of advice about appropriate treatment and whether it should take place in the community or residentially.
Such a system is excellent and I am pleased that it seems to be working in my hon. Friend's constituency. We are supporting such a model through the additional funds that we are putting into drug action schemes. Indeed, only recently the Government made it a requirement for primary care trusts, as part of their performance rating, to deal with drug addiction in their communities. Not so long ago, that was not the case. PCTs must now attend to such issues and we are providing resources for them to do that.
I have visited the constituency of my hon. Friend the Member for Stockton, South (Ms Taylor). She will agree that there are some excellent GP-based services, but another GP service may unfortunately not want to be involved. On one side of the street is a residential shelter run by a charity for those with drug addiction problems, while on the other side of the street is a GP practice that will not help the shelter provide the medical treatment that people need.
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