House of Commons - Science and Technology

Select Committee on Science and Technology Fifth Report

3 Sources of advice

Advisory Council on the Misuse of Drugs

19. The Advisory Council on the Misuse of Drugs (ACMD) was established by the Misuse of Drugs Act (MDA) 1971. It is a non-departmental public body (NDPB) and its terms of reference, as set out by the Act, are as follows:

"to keep under review the situation in the United Kingdom with respect to drugs which are being or appear to them likely to be misused and of which the misuse is having or appears to them capable of having harmful effects sufficient to constitute a social problem, and to give to any one or more of the Ministers, where either Council consider it expedient to do so or they are consulted by the Minister or Ministers in question, advice on measures (whether or not involving alteration of the law) which in the opinion of the Council ought to be taken for preventing the misuse of such drugs or dealing with social problems connected with their misuse, and in particular on measures which in the opinion of the Council, ought to be taken

a) for restricting the availability of such drugs or supervising the arrangements for their supply;

b) for enabling persons affected by the misuse of such drugs to obtain proper advice, and for securing the provision of proper facilities and services for the treatment, rehabilitation and aftercare of such persons;

c) for promoting co-operation between the various professional and community services which in the opinion of the Council have a part to play in dealing with social problems connected with the misuse of drugs;

d) for educating the public (and in particular the young) in the dangers of misusing such drugs and for giving publicity to those dangers; and

e) for promoting research into, or otherwise obtaining information about, any matter which in the opinion of the Council is of relevance for the purpose of preventing the misuse of such drugs or dealing with any social problem connected with their misuse."[23]

The Act also requires the ACMD to consider any matter relating to drug dependence, or the misuse of drugs, which may be referred to it by Ministers. The Home Secretary is obliged to consult the ACMD prior to making any amendments to the Regulations to the MDA (including changing the classification of any drug), although he is under no obligation to follow its advice.

20. The Government's evidence during this inquiry made clear the pivotal role played by the ACMD in the provision of scientific advice on drugs policy. The Government told us that alternative sources of advice included "other published research, consultations with key stakeholders, and the advice and experiences of practitioners within the drugs field upon whom the issue of classification has a direct effect", but acknowledged the ACMD provided "the key advice on classification of drugs".[24] Furthermore, in oral evidence, the Home Office Minister, Vernon Coaker, repeatedly implied that the very fact that the Government sought advice from the ACMD ensured that its policy in this area was evidence based. The Government's total reliance on the ACMD for provision of scientific advice on drugs policy gives the Council a critical role to play in ensuring that policy in this area is evidence based. It is, therefore, vital that the Council is fit for purpose and functioning effectively.

Agenda

21. The Government memorandum stated that there were two ways in which the ACMD's agenda was determined: "Firstly, the ACMD is statutorily obliged to consider any relevant issue referred to them by the Government […] Secondly, the ACMD is at liberty to set its own agenda (in addition to any tasks requested of it by Government) in response to the concerns or issues it is made aware of, either through the professional experience of its members or any other means".[25] Evidence submitted to this inquiry revealed a perception that the ACMD tended to operate primarily in reactive mode. Transform Drug Policy Foundation was of the view that the ACMD was "essentially a reactive body—the Minister dictates its agenda and the scope and remit of its inquiries".[26] We put this point to the Chairman of the ACMD, who vigorously disagreed, telling us that "approximately 40% of the Council's work is initiated by the Council".[27]

22. We also heard conflicting accounts regarding the remit of the ACMD. Transform Drug Policy Foundation asserted that because the ACMD operates as part of the Misuse of Drugs Act 1971, "it can make recommendations for minor tweaks to the policy of prohibition but cannot challenge its basic tenets".[28] Lesley King-Lewis, Chief Executive of Action on Addiction, was also under the impression that "prevention does not come within the remit of the ACMD or the Drugs Misuse Act".[29] This was refuted by Martin Barnes, Chief Executive of DrugScope and a member of the ACMD. In addition, the ACMD told us that some of the work carried out by its Prevention Working Group addressed primary prevention.[30]^,[31] The apparent confusion in the drug policy community over the remit of the ACMD suggests that the Council needs to give more attention to communicating with its external stakeholders.

Consideration of harm

23. The ACMD is required to examine harm associated with the drugs that it considers but, as DrugScope pointed out, there is no definition of harm provided in the Misuse of Drugs Act 1971.[32] In addition, some have argued that the debate around harm too frequently focuses on the inherent harmfulness of the drug itself, rather than on the wider question of harm associated with misuse of the drug. For example, the risk of HIV or hepatitis infection is linked to drug injecting, as opposed to the abuse of a specific drug. Similarly, criminal behaviour may be driven by the need to maintain a supply of drugs to feed an addiction rather than to the misuse of any particular drug.

24. We were surprised to discover a marked divergence of views between the then Home Secretary and the Chairman of the ACMD on the extent to which consideration of social harm fell within the Council's remit. During exchanges following his statement on the classification of cannabis on 19 January 2006, the then Home Secretary Charles Clarke repeatedly asserted that "clinical, medical harm is the advisory council's predominant consideration".[33] Andy Hayman, Chairman of the Association of Chief Police Officers (ACPO) Drugs Committee and member of the ACMD, reinforced this view, telling us: "What is directing what classification a drug goes into is the scientific and medical harm. It has no relationship with the crime that might be associated with it".[34] However, in evidence to this inquiry, Sir Michael Rawlins, Chairman of the Council, directly contradicted this, telling us that social harms (including association with crime) were given "equal weight" in the ACMD's deliberations.[35] The fact that the Chairman of the ACMD and the Home Secretary have publicly expressed contradictory views about the remit of the Council is perturbing. Home Office Minister Vernon Coaker's attempts to reconcile these diametrically opposed positions in evidence to us were not entirely successful but the Minister at least appeared to recognise that social harm should be taken into account by the Council in developing its recommendations.[36] The ACMD must look at social harm in its considerations—it is impossible to assess accurately the harm associated with a drug without taking into account the social dimensions of harm arising from its misuse. We address specifically the apparent misunderstanding on the part of the ACPO representative in the section on the role of ACPO (paragraphs 35-37).

Cross-departmental remit

25. The terms of reference of the ACMD enable it to provide advice to any Minister, not just the Home Secretary. In practice, this facility appears to have been little used. Sir Michael Rawlins told us: "I do not think in my time in office we have been approached by other Government ministers outside the Home Office. The Act would allow any secretary of state to ask for our views, but that has not happened".[37] Sir Michael nevertheless argued that the Council had "very close relationships with the Department of Health" and "relations" with the Department for Education and Skills, Department of Trade and Industry and the police.[38] Officials from the Department of Health and Department for Education and Skills, as well as the devolved administrations and any other relevant agencies, are represented at meetings of the Council and its sub-committees as observers and/or advisers.[39]

26. The importance of effective coordination between departments in this policy area is underlined by the fact that responsibility for delivery of the Public Service Agreement Targets associated with the Government's Drug Strategy straddles three departments: the Home Office, Department of Health and Department for Education and Skills. The relevant Targets are as follows:

i. To reduce the harm caused by illegal drugs […] including substantially increasing the number of drug misusing offenders entering treatment through the Criminal Justice System.

ii. To increase the participation of problem drug users in drug treatment programmes by 100% by 2008 and increase year on year the proportion of users successfully sustaining or completing treatment programmes.

iii. To reduce the use of Class A drugs and the frequent use of any illicit drug among all young people under the age of 25, especially by the most vulnerable young people.[40]

The Home Secretary is charged with taking the lead on Target 1, the Secretary of State for Health has lead responsibility for Target 2 and the Secretary of State for Education and Skills leads on the delivery of Target 3.[41] Clearly, delivery of each of these Targets requires a sound knowledge and understanding of the relevant evidence base and access to authoritative scientific advice. It is, therefore, a serious concern that the ACMD devotes the vast majority of its time and resources to providing advice to the Home Office. We further emphasise the importance of an evidence based approach to drugs education in paragraphs104-105.

27. We acknowledge that some provision has been made to enable departments other than the Home Office to benefit from the ACMD's expertise but the current levels of coordination appear to be entirely inadequate. The division of responsibility for delivery of the Government's PSA targets on drugs policy between the Departments of Health and for Education and Skills and the Home Office highlights both the fact that all three have key roles to play, and the need for robust and effective links between these departments at Ministerial level. The ACMD must be much more proactive in ensuring that it provides and promotes scientific advice to underpin drugs policy in the Department for Education and Skills and Department for Health.

MEMBERSHIP

28. The Government memorandum lays out the criteria governing appointments to the ACMD:

"Members of the ACMD, of whom there should be not less than 20, are appointed by the Secretary of State for a term of 3 years and in accordance with the guidance issued by the Office of the Commissioner for Public Appointments. Nominations come from a wide range of sources including relevant professional bodies, Public Appointments Unit of the Cabinet Office and self-nomination. Under the terms of the MDA 1971 the ACMD is required to include representatives of the practices of medicine, dentistry, veterinary medicine and pharmacy, the pharmaceutical industry, and chemistry (other than pharmaceutical chemistry); and members who have a wide and relevant experience of social problems connected with the misuse of drugs."[42]

Sir Michael told us that, beyond this, "Successive Home Secretaries have permitted me, as chairman, to identify those areas in which I consider the Council needs expertise".[43] The shortlisting process and interviews for candidates are chaired by the ACMD Chairman. A Home Office representative and independent assessor approved by the Public Appointments Commissioner participate throughout, but are not required to have a scientific background or technical expertise in drugs policy. Of the 38 current members of the ACMD, 17 have professional expertise in a science subject.[44] Scientists and other experts may also be co-opted onto ACMD sub-committees as necessary.

29. Several of the witnesses queried the balance of expertise on the Council, with particular concern being expressed over the composition of the Council during its considerations of cannabis in 2001-2 and 2005. The campaigning organisation Rethink argued that there was too much emphasis on professionals as opposed to service users: "To our knowledge, there is no-one with personal experience of using drug or mental health services involved in making cannabis policy. This seems a significant omission especially in the make-up of ACMD".[45] Rethink suggested that "Including people with mental illness and/or substance use problems on such bodies could help ensure that they are more in touch with current issues for people and that views are grounded in experience, rather than preconceived ideas".[46] Mary Brett, retired biology teacher and UK representative on the board of Europe Against Drugs (Eurad) said of the membership of the ACMD: "Where are the biologists, the neurologists […], the toxicologists […], or experts on psychosis and schizophrenia?". She also argued that there was a bias on the Council towards proponents of a more 'liberal' stance: "there is not a single member of an anti-drugs charity, […] one that advocates Prevention over Harm Reduction. Why? There is certainly a preponderance of the other viewpoint […] This committee lacks any sort of balance".[47]

30. In response to these criticisms, Sir Michael told us: "I cannot answer the question as to either whether the membership is liberal or how other people would view it",[48] although he did say that the Council might benefit from having "a few younger people".[49] We note that the Government Chief Scientific Adviser's Guidelines on Scientific Analysis in Policy Making state that "Departments should ensure that their selection of advisers matches the nature of the issue and the breadth of judgement required and is sufficiently balanced to reflect the diversity of opinion amongst experts".[50] We are not in a position to judge whether the current membership is appropriately balanced but emphasise the importance of having a diversity of views represented amongst the experts appointed to reflect the range of views typically held by experts in the wider community. In light of the unusually large size of the Council, we would in any case oppose further expansion of the membership for fear of it becoming unwieldy and unmanageable. Instead, the ACMD's current policy of co-opting experts onto working groups and sub-committees in order to expand access to specific areas of expertise seems eminently sensible.

31. Although the Home Secretary is officially responsible for the appointment of members of the Council, the ACMD Chairman himself conceded that he plays a major role in advising the Minister on the selection of members. On the one hand, it is natural that the Minister should make use of the Chairman's expertise in determining the membership of the Council; on the other, it highlights the potential for the Chairman to exert a very powerful influence over the Council's composition. The presence of an independent assessor ensures that due process is followed during the appointment of individual members, but an independent assessor with no scientific expertise is unlikely to be in a position to make a judgement about the overall balance of scientific and technical expertise represented on the Council.

32. Caroline Flint, then Home Office Minister, told the House in June 2005: "Professor Sir Michael Rawlins was first appointed to the chair of the ACMD in October 1998 for a period of four years. His tenure was extended to a second term, which is due to expire in December 2005".[51] In fact, Sir Michael's term of office has now been extended until 30 September 2008, when he will have completed the maximum term allowed (ten years) under guidance from the Office of the Commissioner for Public Appointments. The Minister went on to say: "Sir Michael is an effective and respected chairman", as well as noting that he was also the Chair of the National Institute for Clinical Excellence.[52] We do not wish to dispute that Sir Michael has been an effective and respected Chairman but we are also not convinced that it is good practice for an individual to occupy such an influential position for such a long time. We recommend that the term of office for the Chairman of the ACMD be limited to a maximum of five years. After this, the individual should, if re-appointed, be permitted to continue to serve on the Council as an ordinary member up to the maximum of ten years.

33. We also note that communication between the Council and the Home Secretary is generally conducted through the Chairman. In our view, the interests of the Council would be better served by the introduction of safeguards to ensure that the Chair is not given inappropriate opportunity to exert his preferences, whether in terms of the appointment of members of the Council or in dealings with Ministers on behalf of the Council. In the final evidence session of the over-arching inquiry, Professor Sir David King, the Government Chief Scientific Adviser, made it clear that departmental Chief Scientific Advisers should be ensuring that advisory committees were adhering to the Code of Practice for Scientific Advisory Committees and included an appropriate balance of expertise.[53]

34. We will consider the functioning of scientific advisory committees in detail in the over-arching Report on the Government's handling of scientific advice, risk and evidence but, in keeping with the Government Chief Scientific Adviser's recommendation, the Home Office Chief Scientific Adviser should be tasked with overseeing the appointment of members to the Council. An example of a departmental Chief Scientific Adviser fulfilling a similar role is provided by the involvement of the Department for Environment, Food and Rural Affairs (DEFRA) CSA in overseeing the work of the Committee on Radioactive Waste Management—a DEFRA advisory Committee.[54] We also recommend that the Chairman always be accompanied by another member of the Council—preferably the Chair of the Technical Committee or the relevant working group—in meetings with Ministers. It should not be inferred from this that we believe the current Chairman to have acted improperly. We will return to the role of the Home Office Chief Scientific Adviser in paragraph 33.

ROLE OF ACPO

35. ACPO has two seats on the ACMD, reflecting the key role played by the police in enforcing the Government's drug strategy. We were concerned to discover a distinct lack of clarity about their role on the Council. In oral evidence, Andy Hayman, Chair of the ACPO Drugs Committee and member of the ACMD, told us: "we have two seats on the ACMD and we will make a contribution to it" but suggested that his contribution did not carry the same weight as that of other Council members: "It has to be said that the input from the police is going to be very narrow compared with other colleagues on ACMD because the main rationale as to why something goes into a different classification is based on medical and scientific evidence, not necessarily on what the police would bring to the party".[55] Andy Hayman suggested that ACPO's role on the Council was essentially passive, arguing that it was not for the police to comment on the appropriateness of the classification of particular drugs: "We do not have a view on what classification is; that is not our job. It is for experts to determine what classification drugs go into and once that is then linked to legislation and police powers and priorities we would then implement that."[56]

36. By contrast, the Home Office has categorically stated on more than one occasion that it expects ACPO to play a full and active part in the ACMD's deliberations. The then Home Office Minister Paul Goggins, for example, said that "Two representatives of the Association of Chief Police Officers (ACPO) are full members of the Advisory Council on the Misuse of Drugs and contribute their expertise and knowledge of policing issues to the council".[57] In evidence to this inquiry, the Home Office Minister Vernon Coaker also told us: "You would expect and hope that the police are bringing that knowledge and experience of dealing with these issues to the committee. In my view, that would be why they are there: to bring that experience, knowledge and understanding to the committee".[58]

37. We have already highlighted the confusion over whether the ACMD should consider social harms alongside clinical and medical harm in its assessments. It is both worrying and perplexing that, in light of the assertion of the ACMD Chairman that the Council gives these two types of harm equal weight, the ACPO representative—a key member of the Council—should still be under the impression that this was not the case, despite having been on the Council since January 2002. It is also extremely regrettable that this apparent misunderstanding has caused the ACPO representatives on the Council to play a less than full part in proceedings. Professor Colin Blakemore, Chief Executive of the MRC and Professor of Physiology at the University of Oxford, correctly pointed out that the police were "in the best possible position" to provide evidence about the relationship between drug use and its social impact.[59] The police are also exceptionally well placed to gather data on, and bring to the Council's attention, trends such that should be informing the Council's work, such as the impact of a change in classification on crime. There is no point ACPO having a seat on the ACMD if its representatives do not bring their expertise to bear on the problems under discussion. The ACPO representatives have as much relevant experience as do other practitioners and academics on the ACMD and they must play a full and active role in developing the ACMD's position. It is highly disconcerting that the Chair of the ACPO Drugs Committee appears to be labouring under a misapprehension about his role on the ACMD more than four years into his term of office.

ROLE OF HOME OFFICE

38. The ACMD has no staff or budget of its own and its secretariat comprises four staff from the Drug Legislation and Enforcement Unit of the Home Office's Drug Strategy Directorate. One argument in favour of this arrangement is that it ensures robust links between the Council and the Home Office, potentially strengthening the role played by the Council's input in policy development within the department. However, critics have suggested that this arrangement also has the potential to compromise the Council's independence. In oral evidence, Professor John Strang, Director of the National Addiction Centre and former member of the ACMD, expressed this very concern, suggesting to us that the ACMD was not sufficiently independent of the Home Office.[60] Whilst not necessarily supporting Professor Strang's view, Mr Hayman, Chair of the ACPO Drugs Committee, did not enhance our confidence by saying he did "not have a clue what the secretariat [provided by] the Home Office does".[61] Although we see the merits of the current arrangement whereby the Home Office provides the secretariat to the ACMD, we acknowledge concerns that this may pose a risk to the independence of the Council. We also note that, in contravention of the Code of Practice for Scientific Advisory Committees, the Home Office secretariat does not possess any scientific or technical expertise of relevance to the ACMD's work.[62]

39. Whilst we fully recognise the importance of preserving the ACMD's independence, there must be mechanisms in place to allow the Home Office to ensure that the Council is functioning properly and providing advice of the highest quality. Rethink has called for "the advice given by Government-appointed bodies such as ACMD and Government policy to be regularly evaluated by external organisations".[63] Nevertheless, in response to a Parliamentary Question asking whether the Home Secretary would make provision for independent testing of the validity of the review process used by the ACMD, the then Home Office Minister Caroline Flint stated that the Government had "no intention" of doing so. Her explanation for this was that the Government "believe in the integrity of the council and its individual members, and are confident that the advice we receive from them is of the highest quality".[64] She also stated that she was "content that the range of professions, and levels of expertise on the ACMD is suitable".[65] It is difficult to understand how the Government can be so confident in the composition and workings of the Council without having sought any expert or independent assessment, and disappointing that it takes such a dismissive view of the need to do so.

40. The ACMD has a critical role to play in provision of advice underpinning a key strand of Government policy. There must be independent oversight of its workings. We recommend that the Home Office commission independent reviews to examine the operation of the ACMD not less than every five years. The first such review should be commissioned as soon as possible to enable the outcome to feed into the current re-examination of the classification system. This review should also address the relationship between the Home Office and ACMD and whether the current secretariat arrangements are working in a satisfactory manner. We will consider the broader issues relating to best practice in scrutinising the work of scientific advisory committees in our over-arching Report. In the meantime, we propose that the Home Office Chief Scientific Adviser take the lead in commissioning a review of the ACMD.

23 Ev 95 Back

24 Ev 55 Back

25 As above Back

26 Ev 65 Back

27 Ev 105 Back

28 Ev 65 Back

29 Q 459 Back

30 As above Back

31 Ev 95 Back

32 Ev 91 Back

33 HC Deb, 19 Jan 2006, col 988 Back

34 Q 388 Back