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24 Jan 2006 : Column 411WH—continued
Addiction Treatment Centres (Weston-super-Mare)
1.30 pm
John Penrose (Weston-super-Mare) (Con): About two to three years ago, I encountered a growing wave of concern in my constituency about the number of drug addicts that my constituents saw in and around the town. On inquiring into the problem in some depth the following year, I decided to launch the Cleaner Weston campaign in the summer of 2004. The aims of that campaign of which I have already provided details to the Minister were threefold. The first and perhaps most crucial aim was to ensure that there was as high as possible standard of addiction treatment and addiction care post treatment for addicts if they were sent to Weston-super-Mare in an attempt to break their habit.
We are lucky in Weston-super-Mare to have a small number of extremely high quality registered addiction treatment centres. They are inspected regularly by the Commission for Social Care Inspection under the terms of the Care Standards Act 2000 and are run by able and dedicated people. The centres are not part of the problem, but part of the solution. However, I discovered that, in addition to the small number of excellent addiction treatment centres, there could be a large unknown number of unregistered centres that provide either treatment or post-treatment care throughout the town.
The difficulty has been in finding out how many centres there are and whether the services that they provide are any good. That difficulty stems entirely from the fact that, so far as I can see, no one is responsible for inspecting the centres, checking that they are doing a good job and that their standards and treatment of care are up to scratch. I suspect therefore that, as with all human endeavour, some of them are extremely well run and provide a high quality of treatment for the addicts in their care, while inevitably some of them might not be as good. The problem in Weston-super-Mare and probably throughout the rest of the country is that, without adequate standards and regular inspection of treatment and care centres against those standards, no one knows whether the addicts are being provided with the care and attention that they desperately need.
I have begun campaigning with the police and the local council for a local accreditation scheme to take into account the registered care treatment centres and also the unregistered treatment centres. I am pleased that, during the past few months, North Somerset council announced plans to introduce a local accreditation scheme in north Somerset for all addiction treatment and care centres in Weston-super-Mare and other parts of the county. I think that I am right in saying that it will be the first such scheme in the country. It is based on the criteria that have been laid out, at least in draft, by the National Treatment Agency for Substance Misuse and the European Association for the Treatment of Addiction.
The crucial point about the new accreditation scheme is that, under the existing rules in the Care Standards Act, registered treatment centres are inspected under a series of criteria laid down originally for residential
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care homes and nursing homes. They are good and worthwhile standards and I do not mean to decry them, but they are not, and were not intended to be, aimed at the central reason for the addiction treatment centres to exist, which is the quality of addiction treatment or addiction care post treatment that they provide. Clearly, it is important to have standards that are fit for purpose and aimed squarely at such an important and specialised area of care.
A proper addiction accreditation scheme is vital. We are introducing one in north Somerset and I should be surprised if the problems that we are experiencing with the quality of addiction treatment and care centres in Weston are unique to Weston-super-Mare. If the Minister considered other such centres in other parts of the country, I suspect that she would find such problems reflected throughout Great Britain.
Mr. David Burrowes (Enfield, Southgate) (Con): I congratulate my hon. Friend the Member for Weston-super-Mare (John Penrose) on raising such an important subject. I have a particular interest in the area because, as a criminal law solicitor for 11 years, I dealt with many drug addicts who were referred to the units in his constituency that he described.
Does my hon. Friend agree that there is a desperate need for an increased number of quality residential units that provide the level of care that we all wish to see, and that such units should be extended as good practice across the country? So far as exit strategy and aftercare are concerned, I have seen clients who attended units without the right exit strategy, and where there was not a holistic approach to their drug addiction and other needs. Some ended up on the streets of Weston-super-Mare, committing further crimes and going back into the system.
John Penrose : I thank my hon. Friend for that intervention. On his first point, a potentially good example of an accreditation scheme is being introduced in north Somerset, and I hope that the Minister will agree to consider that as a pilot scheme that might be rolled out across the country. I shall return to his second point presently, as I plan to address that issue later.
As I was saying, the quality of addiction treatment is vital. The second issue on which we have been focusing in Weston-super-Mare is whether there is notification to the authorities in north Somerset when people from other parts of Britain who are referred for treatment are sent to the town. If someone who is incredibly vulnerable embarks on a course of treatment in Weston-super-Mare, or anywhere, it is important that the local health service, housing service and police be properly notified of that person's arrival, so that if something goes wrong and the person concerned needs additional support or help, the local services are aware of that person's circumstances and can provide appropriate support.
I am afraid to say, however, that that is not what we have found. Since being elected to Parliament seven or eight months ago, I have been writing letters to referring agencies around the country asking questions under the Freedom of Information Act 2000. Sadly, a large proportion are not informing the north Somerset
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authorities of the arrival of the addicts that they are sending for treatment in Weston-super-Mare. That is not good for addicts. If something goes wrong, such as a relapse, and if an addict is picked up by the police without the police knowing that that person is in the middle of a care plan provided by a referring agency in some other part of the country, the addict will go to the local magistrates court and will not be treated in the right way. However, if information can be sought from the agency, a much more effective set of sentences and actions can be taken.
It is crucial that that communication loop is properly closed and connected. I am pleased to say that there are examples of excellent referring authorities around the country. Oxfordshire is one example: in the past two and a half years more than 100 people have been sent by Oxfordshire to Weston-super-Mare for treatment, and in almost every case those concerned have managed to inform the local authorities of when people are arriving, where they are going, and when they will be there. So we are not asking for the unusual or the impossible: it is being done and good practice already exists.
However, rather than one Opposition Back-Bench MP writing letters to referring agencies around the country about people who are sent to his constituency, a more effective approach, if possible, would be Government action pointing out that, wherever addicts are being sent for treatment or support, referring agencies owe them a duty of care to keep people in the relevant referral areas informed, and that if they are failing to do that they should resume promptly.
My final point is that made earlier by my hon. Friend the Member for Enfield, Southgate (Mr. Burrowes). When someone is referred to Weston-super-Mare or another place for addiction treatment or care, that referral should be part of a unified care plan. A session in a treatment centre for several months should be only one step on the road to recovery, and one step on the road towards piecing a life back together and enabling someone to re-enter society and rejoin their family—if that is appropriate—and to get themselves another job. Too often, however, we have found from writing to referring agencies that some of them do not know what has happened to a large proportion of referred addicts in Weston-super-Mare. If there is an effective care plan, the agencies should know what has happened after treatment.
The fear is that if the agencies do not know where those people are, either there may have been no effective care plan in the first place and they were shovelled out of the referring agency's area to get the problem off its front doorstep; or, when the addicts arrived for treatment in Weston-super-Mare, they may have failed to complete the course, relapsed, left the course and ended up on a street corner in Weston, possibly looking for their next hit and probably at high risk of an overdose, which is most likely after an attempt to break a habit, at severe risk of ill health and, from the point of view of local residents, likely significantly to increase the local crime statistics. Addicts in relapse, or those who have not got rid of their habit and have a chaotic lifestyle, are incapable of holding down a job. Therefore, the only way in which they can fund their habit is through crime.
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Mr. Philip Hollobone (Kettering) (Con): I congratulate my hon. Friend on securing the debate. I know how hard he works on behalf of his constituents, and he is raising an important subject. Is not the transition from prison or a place of rehabilitation into normal society a twilight zone through which too many people too often fall? They are not given the necessary support to resume a normal life, and people who might undergo a gradual transition to a sensible lifestyle are sadly lost at that last point.
John Penrose : My hon. Friend is absolutely right. As part of a complete care package and plan, typically after leaving treatment, most care plans will involve a series of steps through half-way houses, dry houses, education and training and voluntary work as a way of re-entering society as one of its fully functioning members. My hon. Friend is correct to point out that people can fall through the cracks in that process. That is why a properly functioning care plan is vital.
My final point to the Minister is that rather than having a solitary Back-Bench MP such as myself with a particular problem in his constituency writing to local agencies that have referred people for treatment in Weston-super-Mare, a far more effective way of dealing with the problem would be through Government action to remind agencies of the duty of care that they owe to people whom they send for treatment—in Weston or anywhere else. That duty is to ensure that people complete their care programme and that when they leave their treatment in any place, particularly Weston, they are not left to sit on a street corner and make their own way.
Those are the three critical issues, and there is a big opportunity for the nation and the Government to pick up on them. I hope that the Government will consider what is happening in Weston-super-Mare and use it wherever possible—potentially nationally—as a pilot for roll-out. I hope, also, that the Minister has had a chance to study the report that the local police authority published, and which my predecessor, Brian Cotter, referred to the Secretary of State for Home Affairs. It set out several of those points in greater detail. I look forward to the Minister's reply.
1.43 pm
The Parliamentary Under-Secretary of State for Health (Caroline Flint) : I congratulate the hon. Member for Weston-super-Mare (John Penrose) on securing the debate. It is a matter of concern to him and his constituents, and to myself, too. Drug treatment today has improved on that of a few years ago. The Government have invested unprecedented amounts of money to provide drug treatment and to do exactly what the hon. Gentleman said: to make better sense of the impact of drug addiction on our criminal justice system, so that we do not continue narrowly, but move from arresting people for crimes that are linked to their drug addiction by giving them a community or custodial sentence without any drug treatment, to dealing with the underlying causes of their acquisitive crime, which is usually the area in which drug addicts find themselves.
During the past few years, the Government have linked crime and drug addiction. The link has been important in obtaining a commitment to, a focus on and
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a prioritisation of that area, through the provision of resources to boost the amount of drug treatment available—whether residential rehabilitation, detox or prescription. The Government have also improved the links between police stations, the courts system and jails. That is why, for example, people are now being tested on arrest in a range of crimes for evidence of class A drugs. So, at the very point of arrest, we can start engaging with people.
The Drugs Act 2005, in whose passage I was pleased to play a part, also makes an assessment in line with the individual's needs mandatory following a positive drugs test. That then follows that person to court, because if they start engaging in their drug problem, it will impact in court upon whether a custodial or community sentence is required. Whether their sentence ends up being community-based or custodial—which is important to the hon. Gentleman's choice of debate today—that seamless approach is needed to ensure that the person is kept on track within a care plan for their drug addiction.
I have seen the information that the hon. Gentleman has sent, and know that it is important for the probation service, which has a role relating to those receiving a drug treatment and testing order—although that term may presently be changed. Basically, as someone on a community-based order involves that service in drug treatment as part of their commitment, a probation service which feels that a residential rehabilitation should form part of that treatment should take ownership for that individual. I was certainly concerned by the evidence that probation services were not informing police or others in the community about someone coming into their area.
John Penrose : One fact of which the Minister may not be aware, but which has developed in Weston-super-Mare in recent months, is that the national probation service has tightened up considerably in response to some of the points that I have been raising. It has withdrawn its patronage from one or two of the addiction, treatment or support places in Weston-super-Mare as a result.
Caroline Flint : I am pleased to hear that. However, it goes to show that even in the context of expanding resources for drug treatment, and despite our development of the drug intervention programme—which provides that end-to-end, seamless approach of supporting people into and through the process of treatment, recognising the issues around housing, employment and so on—we still cannot be complacent. Even with the best will and the best guidance in the world—indeed, the best organisational structure, whether that be the national treatment agency or its regional support—it is not necessarily happening in the best way, as we would hope.
I am indeed aware that there are particular problems in the south-west. Previously, in the Home Office, I visited the south-west a number of times. It is undoubtedly the case that the environment of that region provides a pleasant place to live, often in places
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by the sea and with buildings suitably located for residential rehabilitation—without somebody else living right next door, for there are all those issues about locating these services. Having said that, its very attraction can also be a problem because one issue, as I understand it, is that when people finish residential rehabilitation treatment they may not always go back to whence they came. That then raises a number of issues with a knock-on effect on services.
That is why we expect drug action teams to ensure that aftercare packages covering issues such as housing and employment are built into care planning when they refer a drug abuser to in-patient detox or residential rehabilitation. That should be part of the process. In some cases, residential rehabilitation providers also offer a secondary care package as part of the care plan. Often, they even provide that back in the community from whence the person first came. So, there are good examples of where that can work well, but it highlights—it is important to raise this today—that we must improve the commissioning of services.
There must also be understanding that in referring an individual to an out-of-area residential rehabilitation service, the ownership of that individual and their success should not end there. That is one reason why I was pleased last year when we reached a point where we could say, with hands on our heart, that we had increased the number of people in treatment. That is now at 160,000, ahead of our target, and we have made progress with retaining them in treatment.
The National Treatment Agency for Substance Misuse launched its new treatment-effectiveness strategy to bear down further on successful outcomes. It is recognised that clinical treatment might be necessary, but there is also the wrap-around provision that will sustain someone through the years ahead. Let us face it: in difficult circumstances, people with any addiction may be vulnerable to relapses. This is not only about the here and now; it is about sustainability.
Mr. Burrowes : In relation to the care plan and the ongoing responsibility of the referring agency, I have, unfortunately, come across several instances of people relapsing. That may have to do with the nature of the person or a chaotic lifestyle. We are talking about an ongoing process. Sometimes people relapse and fail; sometimes they succeed. There have been cases of people going to an establishment in Weston-super-Mare but not keeping to the rules. Obviously, they are there voluntarily and can come and go up to a point, but they have failed and been thrown out on to the streets. It is often at that point, when someone has not followed through to the end point for the care plan to kick in and they are left to their own devices, that they end up in the cells.
Caroline Flint : I do not disagree with the hon. Gentleman's point. If a drug action team or social services is paying for a treatment service for an individual, the people who are paying should be clear about what is happening with their investment. Continuity is needed in terms of follow-up and sharing of information. That also applies to providers, whether
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of treatment or housing, in terms of sounding the alert in the community if someone suddenly decides just to leave in the middle of the night. I cannot wave a magic wand and say that that will never happen. The question is: if someone opts out, for whatever reason, what is the process by which that is communicated? If part of the process for someone is that they have not gone to jail, for example, one would want to know, because it was part of their probation conditions, that they were in that treatment. These are important issues; we need to close some of the gaps. It has been clearly indicated that some commissioners of services, those who are referring people, are working well and some are not.
In the short time available to me, I want to talk about action for the future. First, I hope that I have acknowledged that I take this issue very seriously and I am aware of the complexities. Unregistered residential services in the constituency of the hon. Member for Weston-super-Mare are of particular concern. I understand that New Dawn house, Hope house and Sanctuary Addiction Services have been highlighted in that regard. It is worrying if those services are not offering effective treatment. There seem to be issues at the commissioning end. Perhaps those who commission are sometimes not doing as much work as they should to ascertain the nature of the services. In some instances, it is accommodation, rather than effective treatment, that is provided. Those paying for the service need to know exactly what they are paying for and what they should expect from it. To know that, they have to engage with the treatment provider and should be consulting the NTA and others about information that can give them a better picture of what they can expect for their investment.
I am pleased to say that, despite the problems, it is clear that the different local stakeholders in the hon. Gentleman's area are aware of the problem. The report to which he refers, by Avon and Somerset constabulary, is very helpful. It was put together in conjunction with a number of people in the health sphere who are concerned about the issue. I understand that a number of actions have been considered, the first of which is the development of a system of local accreditation and quality assurance in line with the NTA standards, which will help placing authorities to understand better the risks of placing clients in the areas that we are discussing. I understand that, under that scheme, Sanctuary Addiction Services is working with the local drug action team to improve its clinical care practice to meet required standards. I am interested in that work and how we might consider it in the context of the national picture. I shall discuss that shortly.
Correspondence has been sent to probation areas nationally to set out concerns and to ask, for example, that placements at Hope house stop. I understand that that has already had a significant impact. A letter will be sent to all directors of social services reminding them of their statutory duties in relation to the aftercare of those placed out of area.
Through the NTA regional commissioner's forum, agreement was made with neighbouring local authorities such as Bristol City not to place clients in unregistered care homes. Working with the NTA, the Office of the Deputy Prime Minister, the Commission
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for Social Care Inspection and Supporting People, funding for New Dawn house has been terminated, and New Dawn house is expected to close in July 2006. Operation Jupiter, which was carried out by Avon and Somerset police in partnership with the local drug action team, targeted 20 local houses in multiple occupation associated with high levels of criminal behaviour with very positive results.
The recently submitted draft 2006–07 drug treatment plan signals a clear and continuing commitment to improving local service quality and capacity and to engaging pragmatically to address the problems posed by unregistered care homes. I understand, however, that this is a problem not only for the hon. Gentleman's area; it could be happening in other parts of the country. The work that is being done locally gives us some idea of how we could approach the problem nationally and how we can discuss what other steps the NTA can take, certainly through its regional arms, throughout England.
As I said, the problems identified in Weston-super-Mare are experienced nationally, and to assist the process I have asked the NTA to produce an action plan on how those problems can be addressed nationally and for regular progress reports. I shall seek discussions with my colleagues in the Home Office, as it is jointly responsible for the NTA. The NTA is accountable both to the Home Office and to the Department of Health, and is required to assist us with any criminal justice issues that need further investigation.
Before I conclude, I must say that we are doing a huge amount nationally to improve the effectiveness of residential substance misuse services. There are challenges in referring people to out-of-area services, as well as in not referring people to residential rehabilitation when it is in fact in their best interests. Hon. Members will know that it is often a big problem for local funders to decide whether to keep people in the area or to send them out. That is true in many respects for specialist children's services, for example.
We are trying through the effectiveness strategy to place a renewed emphasis on the whole journey of someone who is trying to find their way out of drug addiction and on how drug treatment systems can support that. I believe that drug action teams have a responsibility to put in place a package of support that covers assessment before someone enters the residential rehabilitation service, the period in the residential care setting and aftercare when they have left the service.
As I said, the aftercare package should include housing and employment and the commissioning drug action team, irrespective of whether the person resumes residence in the area in which they lived before they had treatment or whether they go to a different area. There needs to be a better connection to make sense of the considerable investment in giving the individual another chance.
We need to tackle variations, and several pieces of work are planned to ensure that the quality of that commissioning is improved. That work includes guidance on commissioning residential rehabilitation and in-patient detoxification services and other work to promote good practice and to improve tier 4 commissioning, encouraging the use of local flexibilities
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in the pooling of community care, and developing regional and sub-regional commissioning mechanisms. A region might explore more creatively what residential services it needs to make sense of the post-residential rehabilitation experience of coming home and the aftercare packages. As I said, work is also being done to improve and to promote the evidence base and consensus on suitable clients for tier 4 provision.
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As I have also said, a huge amount of work is being done. We must always ensure that we are not complacent, even though so much progress has been made in identifying drugs as a link to crime, in providing the resources to make a difference, and in understanding that effective treatment can be important for the wider community as well as for the individual.
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