Q
21Paul
Rowen: In Oldham, Paul, you have been lucky to have the
co-operation of the primary care trust so you have a firm measure of
control over community services and adult social services. That is not
included in the regulations in this Bill. I am thinking of an example
of a young man who went to university; we had to get everyone together
on a Friday afternoon. The council had agreed its money; the university
had agreed what it was going to do. The PCT was reluctant to finance
the support that young man needed. Will people be able to get the
lifestyle changes that they want without adult and community care
control as well?
Paul
Davies: I would say two things. The first is not as
flippant as it sounds—the harder we work, the luckier we get.
Secondly, in terms of the duty to co-operate between the organisations,
you are describing a situation that I am familiar with from across the
country. It is probably the thing I get the most phone calls
about—people asking whether there is a better way to do it. It
is a fine example of not being able to join the whole system together
around that individual.
There is
another stream of work to be done about the duty for other bodies to
co-operate, not just in employment. It is back to the vision and
everyone playing their part in that. As the regulations stand, it is
perfectly possible that someone could be receiving an individualised
social care budget and, as their health deteriorated, move into a
continuing health care arrangement but then find that they had lost all
choice and control in that arrangement because the funding was coming
through a health stream. There is good work going on in the health
stream, looking at integration, but that is only in the health
stream.
Q
22Paul
Rowen: Should a duty to co-operate be included in the
Bill? Paul
Davies: I would say so;
yes.
Q
23The
Chairman: We seem to have exhausted our questioning, so
before we thank you, do either of you have any final thoughts that you
wish to leave these parliamentarians with, to have in the back of their
mind as they go on to consider the Bill?
Liz
Sayce: Access to Work is a very successful programme
and brings back about £1.70 for every £1 spent on it. The
recent announcement that the budget for Access to Work is to be
increased is very welcome, but the programme has not delivered
equitably for all disabled people. In particular, it has not worked so
well for people with a fluctuating condition or a mental health
condition. There is a real imperative to use that additional resource,
ideally to make the support into work an entitlement. The support
should be on offer as part of the quid pro quo: you will take
responsibility for taking up employment, if you are able to, and the
Access to Work support should be there, and more equitably so. In the
White Paper there were welcome references to improving these services
for people with fluctuating conditions, including mental health
conditions. It is a very cost-effective programme and the more that can
be done to make it available to everybody who really requires it, on an
equitable basis and almost as of right, the
better. Paul
Davies: I have a couple of things to say. My first
point echoes that last point. Our experience in adult social care with
people with fluctuating conditions is that everybody is assessed as
though they were on their worst day—that is the way things work.
Everyone is not always on their worst day, but they are assessed as if
they were. There is not then the flexibility to deal with changes in
the condition, to be able to roll forward money or take money from a
forthcoming arrangement. That is very much a self-service model, and
one that works for people and reinforces the choice and control. It is
also a more efficient model, as any self-service catering arrangement
demonstrates. So I think there is room for making all this work in a
way that reinforces what I will say next.
Through
absolutely nobody’s fault, we have socially excluded lots of
people in this country over the years, as much because of systems as
anything else, and this is a fantastic opportunity to link up the
various systems and ensure that they all play their part in delivering
the vision for the individual, which I know is shared around this room.
It is the right moment to do it. If we do not do the things that I and
my colleague have spoken about, we will end up with a lot of people who
never get to maximise their full potential.
My experience
in Oldham—this is also the experience elsewhere in the
country—is that everybody has something to contribute, and
enabling them to contribute brings to fruition all the things that we
all want. If we insist on keeping people at home and on benefits, we
are losing a marvellous opportunity to get people to play their full
part in our
society.
The
Chairman: Thank you both very much for your time, for your
evidence and for how you have responded to
questions. 11.54
am
Q
24The
Chairman: I welcome our two witnesses from DrugScope, Dr.
Roberts and Mr. Barnes. Would you introduce yourselves and
explain who you
are? Martin
Barnes: I am the chief executive of DrugScope and
have been with the charity for nearly five years. Prior to that, I was
the director of the Child Poverty
Action Group, so I find it interesting that we have the benefits side
and the drugs side coming together on this
issue. Dr.
Roberts: I am Marcus Roberts, the director of policy
at DrugScope. I have had two stints at DrugScope, between which I was
head of the policy and parliamentary unit at Mind, the mental health
charity. I have also done a stint at the National Association for the
Care and Resettlement of Offenders, so those previous posts give me an
understanding of crime, drugs and mental health.
Q
25The
Chairman: Before colleagues ask questions, I invite you
both to make a statement reflecting on the Bill. It does not matter how
long you
take. Martin
Barnes: Going back to the publication of the new
drugs strategy last February and its commitment to improve drug
treatment effectiveness and the outcomes for problem drug users, we
welcome what is very much a new and positive emphasis on the importance
of reintegrating people who are in or completing treatment. Linking the
drugs strategy with the Government’s wider agenda of tackling
worklessness, social exclusion and poverty was a welcome development.
With regard to the Bill, clearly we strongly support the commitment to
provide more support for problem drug users, particularly those in
treatment.
DrugScope is
a membership body for people who work in the drugs field or similar
professions and basically share a common goal to minimise drug-related
harms. We consulted extensively on the Bill’s proposals, as they
appeared in the Green Paper in the summer, and there was universal
welcome for the commitment to help problem drug users to reintegrate
themselves and to provide more support through the benefits system for
them to engage with training and employment.
However,
there was considerable concern about the conditionality that linked the
requirement to undergo treatment with the benefits system, and some of
the initial proposals intended to enable the Department for Work and
Pensions to identify problem drug users. There were considerable
concerns about some of the initial proposals set out in the Green
Paper, some of which have now been abandoned, particularly the proposal
that it would be a condition of benefit to declare whether you were a
crack cocaine or heroine user. We are pleased that that has not
progressed.
It would be
fair to say, however, that many of our concerns remain, and those come
from members who work with problem drug users day in, day out. Some of
our members who deal with the more challenging and marginally socially
excluded members of our community were concerned about the various
proposals on identification, the sanctions requirements, and the idea
that they would have to undergoing drug treatment at the risk of
benefit
sanctions. Dr.
Roberts: I do not have much to add to that, but would
like to underscore a couple of points. The commitment to get more
problem drug users into work and help them along the path to employment
is really welcome, but it is important to be realistic about the
barriers that prevent many such people getting into employment. The
range of barriers includes problems with skills and experience of work,
problems with CV gaps and poor employment histories and problems with
employers’ attitudes—that can be described as stigma,
but it is more generally about employers having anxieties about working
with that group. That is why some of the material in the Gregg review,
about recognising that there are people in the benefits system who
should not simply be abandoned and written off, but are none the less
quite a long way from a place where they could step into mainstream
employment, is important. The issues about how we support that group
are really important, but also quite thorny and tricky and need some
thought.
Not only do
we have problems with the impact of the sanctions regimes, but it is
also quite likely that a system that was better at encouraging people
to voluntarily disclose drug problems, which included a promise that,
if they did, they would get proper support, encouragement and help,
could more effectively identify people and bring them forward in ways
that engage them more productively with treatment services than the
stick of sanctions. On that point, the Government’s voluntary
progress2work programme, which I think has been running since 2001, is
linked to jobcentres and helps problem drug users to get into training
and work and provides assistance on issues such as housing and debt. We
would like to see that work being built on, and would have liked to see
more evaluation and thought about the effectiveness of that approach
being fed into the
Bill.
Q
26Meg
Munn: In the last session, we heard about the importance
of organisations working together to look at the range of issues for
people who are considering getting back to work or getting into work
for the first time. I assume that we would say exactly the same things
about drug users: it is not about one part of their life, but about the
whole range—it is about accessing treatment, accommodation
issues, other health issues and Access to Work. Are you saying that
there are things in the legislation as drafted that would prevent that?
Are there things that we should be more directive on, as Mr.
Davies said in the last session? There are sanctions, which seem to be
the right thing at some point, but are there other ways in which the
Bill could be improved to deliver the services to assist
people?
Martin
Barnes: The measures in the Bill specific to problem
drug users, clause 9 and a new schedule, do not articulate what the
positive support for problem drug users will actually be. The proposed
legislation talks about things such as the identification requirement;
the requirement to attend an interview; referrals for a substance
misuse assessment; information sharing with the police, the probation
service and others; the fact that a rehabilitation programme can be
imposed on a claimant; and the fact that somebody can be directed to
attend a specific place or institution for treatment. The Bill does not
articulate what Ministers have described as the vision and aspiration
to provide more support for problem drug users. That is the part of the
Green Paper and the drug strategy that we welcomed and support, hence
our concern about the Bill as it currently stands. There are other
elements of the Bill that give the Secretary of State powers to provide
additional financial support for certain people, such as those on
jobseeker’s allowance. We do not have any similar provisions
specific to problem drug
users. There
are already some fairly positive developments under way. You are
probably aware that the Department of Health is funding what are called
drug co-ordinator posts. Every jobcentre district in England will have
dedicated staff who will work with local partners to encourage better
understanding and good practice in the DWP and will very much become an
additional resource in terms of building local partnership and
planning. The National Treatment Agency for Substance Misuse recently
published new guidance to encourage and support better commissioning
practice on supporting problem drug users on to the various pathways to
access training and employment. But that is quite top-level; the
difficulty is getting the partnerships and planning happening on the
ground, and inevitably, that often comes back to the question of
resources. If
the aim of the Bill is delivered in terms of identifying more problem
drug users through the benefit system and trying to get them into
treatment, that will clearly put additional capacity pressures on the
drug treatment system. Although we have seen significant increases in
investment in drug treatment, which has been very positive and
cost-effective and is showing positive outcomes, the pool treatment
budget for the next three years is frozen in cash terms. Furthermore,
the spend per person on drug treatment has been falling, and although
efficiency savings—as they are inevitably called—can no
doubt be found, at a time when drugs services and their partners are
rightly expected to do more for problem drug users by helping them into
housing, training and employment, the resources available to do so are
actually falling in real terms in many
areas. Dr.
Roberts: May I just make three very quick points on
why the Bill might not help in accessing some of that other
support?
First, a lot
of the Bill is about getting people to disclose problem drug use,
because if they disclose that they have a drug problem they can be
helped and supported. I think it is important to contextualise that,
because people’s experience will be that disclosing drug
problems is a consistent barrier to their accessing support, whether it
relates to housing or employment. It is important to be aware of the
reasons why people might be reluctant to
disclose. Secondly,
and more directly, I think that one impact of benefit sanctions could
be damaging to some of the recovery capital that people rely on in a
very direct way. For example, we recently held a seminar to discuss
such issues with Adfam, a charity that works with the families and
carers who work with drug users. Its concern was that, where benefit
sanctions are applied, families, parents and so on will quite often
pick up the financial slack. That could damage the supportive family
environments that can help people get their life back on
track.
My last point
is a more general one about the political discourse. If you have a
political discourse that portrays drug users on benefits as people
whose primary problem is that they are not sufficiently motivated and
may need to be sanctioned into actively seeking work and help, that
creates a picture in the eyes of employers and others who might provide
things like housing that does not speak positively of this
group.
Q
27Meg
Munn: I am sorry; are you saying that people currently
have a very positive image of drug users and that the Bill will make it
worse? Dr.
Roberts: No; I am not. I am saying that people
currently have quite a negative perception of drug users, and that that
in itself is a substantial barrier to their
accessing things such as work and housing. If we are serious about
getting that group socially included and into work and support, part of
what we need to do is to help remove some of those perceptions, or work
with people in ways that support them to engage more positively with
that
group.
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