Examination of Witnesses (Questions 1-77)
THE HOME
OFFICE AND
NATIONAL TREATMENT
AGENCY FOR
SUBSTANCE MISUSE
10 MARCH 2010
Q1 Chair: Good afternoon. As I said
to the NAO earlier, 400 down; four more to go, as far as I am
concerned. We are in the final leg now and today we are looking
at an important subject, tackling problem drug use. We welcome
back to our Committee Sir David Normington, who is Permanent Secretary
at the Home Office, who is a veteran of this Committee, Mandie
Campbell, who is Director General of the Drugs, Alcohol and Partnerships
Directorate at the Home Office, and also Paul Hayes, who is the
Chief Executive of the National Treatment Agency for Substance
Misuse. You are all very welcome. This is obviously a very big
programme. The Government spends £1.2 billion a year
tackling the problems or hoping to tackle the problems posed by
an estimated 330,000 problem drug users in England. Sir David,
if I may start with you and refer you to paragraph eight of the
Comptroller's Report on page five, it starts off by saying, "Neither
the current Strategy, nor the supporting action plan for 2008-11,
set out an overall framework for evaluating and reporting on the
degree to which the Strategy is achieving the intended outcomes
..." Sir David, how are you going to evaluate and measure
your success?
Sir David Normington: I think
we have concentrated on evaluating so far the main areas of spend.
There are a number of gaps in that and we have not had an overall
framework of evaluation. We accept that in the new Strategy that
is what we need to have, but I would not want people to think
that we have not evaluated our main areas of spend. We evaluated,
for instance, the huge spending that there has been on treatment
and there is a very good return on investment for every pound.
We estimate—and this is well validated—a £2.50
return for every pound spent on treatment in terms of benefit
in cutting crime and other harms. We have also evaluated our other
big element of spend which is the Drug Interventions Programme,
which is the thing that ensures that people who come into the
criminal justice system get referred to treatment and take it
up. Both those, which are the main areas of spend, are showing
very good returns. Although we have not evaluated the whole programme
and we accept that, we have evaluated the main areas of spending.
Q2 Chair: Obviously to get proper
evaluation we need accurate figures. I should have asked the NAO
to start this hearing by issuing a correction to the Report.
Mr Morse: We have given all the
members of the Committee a sheet setting out the corrected information.
This was information very helpfully supplied by the Home Office
and I am afraid we had understood it otherwise than we should
have done. I know we have been in discussion with you about it,
so that is how that misunderstanding arose. The correction is
set forth in that sheet and I have already discussed it with the
Committee.
Sir David Normington: It is figure
six on page 26.
Q3 Chair: Thank you for that. I want
to ask you now, Sir David, about the very important problem caused
by crime. If we look at 1.5, "The estimated annual costs
to society associated with problem drug use are £15.3 billion
... Of this figure ..."—a staggering, in my view—"£13.9
billion is the estimated annual cost of drug-related offending
(mainly acquisitive crimes ...". This is about protecting
the public and many people feel quite strongly about this. We
can talk about how to help these people in a moment, but some
of these people in order to feed their drug habit may be knocking
off as many as 30 houses a week and they are leaving a trail of
misery and destruction, particularly with elderly people. A lot
of us have had our houses burgled. We know it is just absolutely
humiliating and horrible to come home to, so this is a terrible
problem. I could ask you what you are going to do about it but
let us just start by getting you to comment on this and then we
can perhaps pursue it further during the hearing.
Sir David Normington: If you take
the category of acquisitive crime, which is basically burglary,
theft and similar crimes, about 30% to 50%—and it is hard
to estimate—is drug-related, ie, people doing it because
they need the money to feed their drug habit. That is why it is
so important that, when people get caught, get arrested and get
to the police station, one of the things that happens now which
did not happen before is they are tested for drugs.[1]
They are assessed on what their need is for treatment and then
they are put under quite a lot of pressure, although it is not
absolutely compulsory, to take up that treatment. It is why we
focus so much of the resource on first of all really stepping
up the amount of treatment that is available and also making sure
that people who come into contact with the criminal justice system
take up that treatment. That is where we know it works. We know
that the Drug Interventions Programme actually requires people
who come into the police station and get drug tested to get assessed.
If they go into treatment, it cuts their offending overall by
26%. That is a proven figure. The basic thing is to provide really
good treatment, to make sure it is available very fast, to keep
them in it and to make sure that when you are in the criminal
justice system you are obliged to undergo treatment. That is the
best way. There are lots of other things I am sure we will talk
about but that is the core of it.
Q4 Chair: Listening to that, it sounds
fine but why do we read then in paragraph 2.3, which we can find
on page 22 of the Report, that over a quarter of problem drug
users showed a sharp increase in offending while on the Drug Interventions
Programme? We have to be absolutely fair. Around half showed a
decline in offending but you obviously have this hard core who
are leaving a trail of misery and destruction after them. Despite
your no doubt good efforts—it is costing a lot of money—a
quarter of problem drug users showed a sharp increase in offending.
Sir David Normington: These are
the chaotic people who first of all often refuse to take treatment
and then, if they go into treatment, drop out of it. We are dealing
with a really tough group here. It would be amazing if everybody
who went into this programme actually came out of it treated.
You are really talking here about the prolific offenders. What
is important about this group is that they are picked up by things
like the Prolific Offenders Programme which gives them intensive
attention and basically eventually they will be got into treatment
and hopefully they will be got off drugs; but you may have to
have several attempts with them because we are dealing with, as
the Report shows and as you are describing, a very difficult group,
a very chaotic group, people who are not used to being in any
kind of pattern of employment and so on. We are talking about
that kind of person so they will be people who have got into the
habit of committing crimes.
Q5 Chair: Speaking as an ordinary
member of the public would speak, why can we not bring these people
into secure accommodation—prison, whatever you like to call
it—give them a proper course, try and get them off drugs
and keep them off drugs? We have another Report which I have just
been briefed on, which is going to come to the Committee soon,
on how we are dealing with people who spend less than a year in
prison. Ever since I was working in the criminal Bar, I have long
been convinced that short prison sentences simply do not work.
People do not have enough time to stay in a secure place for long
enough. They do not get put on courses and all these other problems.
It seems that too many of these people are coming in for short
terms, being spat out by the system and then reoffending and causing
misery in their wake. Better action is to get a grip on them and
bring them into a secure place where they can receive long-term
treatment.
Sir David Normington: That does
happen. Paul Hayes may want to just add to this. The one thing
in that Report today, which I have only briefly looked at as it
is published today, is that it actually does commend the work
that has been done on drugs. We are getting much better in prisons
at keeping people in drug treatment and then meeting them at the
prison gates and continuing them in treatment as they come out
of prison, which is essential. Of course not everybody goes into
prison and you may want to say something about residential and
secure facilities.
Q6 Chair: Mr Hayes, you are obviously
the expert in this. Would you like to comment now?
Mr Hayes: The first thing to say
is the Drug Interventions Programme is not a sentence of the court.
It exists to operate before people are sentenced so that we have
every opportunity to get people in contact with treatment as soon
as they are arrested and throughout their passage through the
criminal justice system. The people who have been through DIP
will eventually go to court. They will be sentenced. They will
be sentenced to drug rehabilitation requirements, to a period
in prison, to other forms of community supervision where there
will be other opportunities to get them into treatment. The Drug
Interventions Programme is the first stab we have at trying to
reach them but not the only one. Exactly as has been said, what
we know is if we get people into treatment—I emphasise "into",
not "through"—as soon as they are in contact with
treatment, their offending reduces very significantly. That will
be sustained while they maintain contact with treatment. Clearly,
there are some people who will either not make it to treatment
as part of DIP, because it is largely a voluntary scheme; there
will be other people who will drop out early but, across the whole
population in treatment not all of whom have arrived via DIP,
we know if we get them into treatment the overall offending by
that cohort will be halved. That is a very significant benefit
to the community.
Q7 Chair: Sir David, you can convince
us, can you, that our prisons are not awash with drugs?
Sir David Normington: I can convince
you that there is quite a lot of evidence that drug use in prison
is very sharply down. I cannot say to you that there are no drugs
in prison of course. There have been huge efforts to reduce the
supply of drugs in prison. I think the figures show that drug
use in prison—it is very difficult to measure of course—is
down from 27% to 7%, but that is still too many.[2]
Q8 Chair: Mr Hayes, if we look at
figure five, we see that we spent £2.8 billion of funding
treating drug users in the five years 2004-05 to 2008-09, so we
know that more people are being treated but what I want to get
from you is: what have we to show for all this expenditure in
terms of fewer people relapsing and more people being less dependent?
Mr Hayes: Throughout that time,
about 300,000 people have been in and out of the treatment system.
125,000 of them have left and have not only not relapsed and come
back to treatment but also have not shown up in the criminal justice
system. That is a very significant number of people who appear
at the moment to have overcome their addiction and are actually
beginning to make a fresh life for themselves. Drug treatment
does not only deliver that. It delivers benefit in three dimensions.
First of all, crime, as we have been talking about, very significant
reductions in crime, and that is what has justified the huge increase
in investment in drug treatment we have seen since 2001. That
has been an explicit policy thrust, to invest health resources
in drug treatment in order to reduce crime but also by doing that
we improve public health and individuals' health. If we get people
into treatment, we know within six months from the monitoring
that we do, from something called the Treatment Outcomes Profile
recently written up in The Lancet, so a highly respected
medical journal, that two-thirds of heroin and crack users are
either abstinent or have significantly reduced their use six months
in. Similarly, readers of the British Medical Journal will
have seen in the most recent edition another study that we have
done based on treatment outcomes profiling into powder cocaine
users showing 60% of them are abstinent and another 10% are well
on the way to abstinence. In addition, we can also demonstrate
very significant public health benefits. Once we started investing
significantly in drug treatment, what appeared to be the inexorable
rise in drug-related deaths that had been taking place between
1993 and 2001 abated and that has largely been flat lining since
then. We also, because of the investment in drug treatment, have
the lowest rate of HIV infection amongst drug users in Western
Europe and dramatically lower than the figures in Eastern Europe.
Finally, around individual social functioning, one of the major
drivers of family breakdown, worklessness, fecklessness, poor
parenting, is drug addiction. We know, if we can get parents into
drug treatment, their children will be at much less risk. They
are more likely to be in work. They are more likely to be socially
connected and therefore society gets a very significant return
on investment.
Q9 Chair: All that we accept and
your answer is very fluent, but when I was talking to the NAO
they reminded me—it is in this figure here—you have
195,000 people receiving treatment but they tell me that only
9,300 are leaving free of dependency every year, so there are
two figures, 195,000 and 9,300. Whatever you say, however fluent
your answer, it does not strike me as if you are getting a lot
of people off drugs.
Mr Hayes: Two things there. We
have to be very careful with the terminology as we have already
discussed before the meeting began. Of people in treatment, it
is actually 25,000 left last year free of dependency. Of problem
drug users, it is 15,000. The 9,000 is a sub-category of that.
Q10 Chair: Let us get these figures
right. Aileen, explain this to us, will you?
Ms Murphie: 9,300 people left
free of dependency on the drug that they presented with.
Q11 Chair: Is that not a reasonable
figure?
Mr Hayes: No, because another
6,000 left free of any illegal drug use.
Ms Murphie: Plus 5,700 left free
of any illegal drug use, which would include cannabis.
Mr Hayes: Hence 15,000 of the
problem drug users who left free of dependency, which must include
those who are not using anything at all. The reason for that is
dead simple really. They are addicted. If they were not addicted,
then there would not be a problem but addiction is a chronic,
relapsing condition. It takes years to get better. You do not
do it in one fell swoop. It is characterised by a number of failed
attempts to get better, false dawns, and it would be like that
for you and me. The problem drug using population is not actually
like the rest of the population. It is a very distinct subset
of the rest of the population. About 40% of people in our society
use drugs at some stage in their life. They are much the same
as the rest of us. They will tend to be rather more male than
the rest of us and more inclined to take risks than the rest of
us. They will be across all socio-economic groups and they live
in all parts of the country. Only about 20% will use drugs at
all regularly. Most of those 40% will stop once or twice. 20%
will use drugs on a more or less regular basis, the vast majority
of whom will be using cannabis and only cannabis. Regular class
A use is about 3% of the population. The numbers who use heroin
and crack, the people we are talking about here today, are so
small that we cannot actually count them through the British Crime
Survey that we normally use. We have to use special counting methods
to identify them. That is where the 320,000 comes from. They are
very different to the rest of the drug using population. They
are not drug users who were unlucky and became addicted. They
will be concentrated in our poorest communities. They will be
the people who have been in the care system. They will have been
in and out of prison. They will have poor mental health. They
will have been failed by the education system. They are people
who would have a multiplicity of problems in their lives even
if they had never stumbled across heroin or crack. If you can
imagine how difficult it would be for you or me to overcome addiction,
for that population it is much more difficult. On average, it
takes four years, a number of goes round the roundabout and a
number of false dawns but, in the end, most of them will either
get better or they will be held stable, causing fewer problems
to themselves and, through crime and public health risks, far
fewer problems to the rest of us.
Q12 Chair: When it is quite obvious
that the way to deal with this is to get these people into long-term
residential care, one-to-one, why have you closed the wonderful
Middlegate Lodge in my constituency which had a national reputation
for getting in the most difficult young people, treating them
one-to-one at great cost, I agree, but better to treat them there,
in rural Lincolnshire for several weeks, get them off drugs and
give them a life, rather than closing this centre down because
it costs money. Why did you do it?
Mr Hayes: I did not, is the bottom
line.
Q13 Chair: Your regional director?
Mr Hayes: No, not at all. There
are a number of factors there. First off, you began by saying
the solution is to get people into residential rehab. Are we talking
about adult rehab or young people's rehab? If we are talking about
Middlegate and the young people's system, it is very different.
This Report does not touch on the young people's system at all.
Before we can move on to Middlegate, perhaps we need to sketch
in what happens with the young people's system.
Q14 Chair: I want to get on to Middlegate
or my colleagues will get angry.
Mr Hayes: I recognise that you
want me to be brief but if you bring issues that are not within
the Report to the table then what do you expect? There are 25,000
young people receiving services because of their drug or alcohol
use. 24,000 of them are not addicted. They are young people who
are truanting, offending, where drug or alcohol misuse plays a
part in that behaviour, but is not driving it. There is a very
small number of young people who do have significant problems
and a tiny fraction of them will need to be looked after in residential
provision. This is the responsibility of the Department for Children,
Schools and Families. Those services are commissioned not by the
drug action teams and the partnerships that they represent. They
are commissioned by children's partnerships locally and they are
commissioned underneath a strategy that the Department for Children,
Schools and Families has for children with difficulties. Very
few children who are addicted have only either an alcohol or a
drug addiction problem. They tend to have a multiplicity of problems.
DCSF and Children's Commissioners are looking to build a web of
services around those individuals to deal with their challenging
behaviour, their mental health problems, their offending, not
just their drug or alcohol misuse issues. DCSF also says that
children are dealt with much better within their own community.
Q15 Chair: You do not really believe
that, do you?
Mr Hayes: I believe every word
of it.
Q16 Chair: You do not believe that
full-time, one-to-one residential care for the really difficult
young people is the best thing to do?
Mr Hayes: What I believe is that
very few of them actually need residential services, number one.
Number two, those residential services can be provided nearer
their home. One of the things we know about adult residential
services as well as young people's residential services is it
is the eventual return to the community that matters, particularly
if you are 15 or 16. You need to be as near your family as possible.
You need to be as near your mates as possible. You need to be
able to re-establish your life once you have gone through a period
of crisis. The Government have said that is their policy for troubled
youngsters. One of the troubles that kids who have difficulties
have is around alcohol and drug misuse. One of the problems we
have is that as a society we believe that a drug problem trumps
everything else and exists in isolation. What Middlegate sees
and you are putting forward as its unique selling point, that
it is focused on the drug problem and is located in the middle
of Lincolnshire, is actually what the DCSF strategy would see
as being what is wrong with it. It is too focused on drugs and
alcohol and not enough on the rest of the problems and it is not
in the young person's own community.
Q17 Chair: One last question to you,
Sir David. Clearly, it helps these people to be housed. We are
spending a lot of money, £30 million, on housing. We all
accept that but let us be real. We all know that local people
do not want these houses next to them so what are you going to
do about it? How are you resolving this problem? I know it is
an unanswerable question.
Sir David Normington: It is really.
I cannot resolve that conflict of priorities. For any local authority
that has all kinds of demands for its housing, in many areas drug
users are going to be competing with lots of other cases which
actually the public would think, probably rightly, were more deserving.
What the £30 million represents is the amount of money that
local authorities agree to spend on that. They are not compelled
to spend that. They get a budget to support vulnerable people
from the Department for Communities and Local Government and they
actually spend £30 million of that on helping drug users.
This can be, as you well know, very, very controversial. On the
other hand, we know from the evidence that if you can stabilise
the housing situation of problem drug users they are more likely
to stop offending and to stay off drugs. Of course I cannot resolve
that. Locally, the conflict is enormous. What is true is that
if you do not do this and these people become homeless or they
move from place to place, they can create a lot of problems for
the law abiding community as well. You can explain it to the law
abiding but it is tough.
Chair: The hon Member for a less remote
part of Lincolnshire, Mr Austin Mitchell.
Q18 Mr Mitchell: I am not commenting
on whether Lincolnshire would drive anybody to drug use or to
drug rehabilitation but I was interested in Mr Hayes's evidence
and the impressive manner in which it was delivered. Two questions
arose from it, to my mind. If it is not argued or claimed that
residential care and one-to-one care is a solution for these people,
why are celebs and the better off prepared to pay so much to go
into The Priory and other places for exactly that care?
Mr Hayes: That is a very good
question. I think that is one of the reasons why there is a sense
that anything that does not mimic that must be sub-optimal. I
do not know the quality of care those individuals receive. What
I do know is they are very often back on the front pages shortly
after, after it has not worked.
Q19 Mr Mitchell: You do not have
the statistic, do you?
Mr Hayes: What we do know is that
residential rehab is a very effective treatment.
Q20 Mr Mitchell: It is also very
expensive.
Mr Hayes: It is. It is effective
for the right people. It is cost effective if you get the right
people there.
Q21 Mr Mitchell: What I am asking
is: are we cutting down on that because of the cost—in other
words, to save money—or because it is not an effective treatment?
Mr Hayes: Neither. What we are
doing is trying to get the balance right. Every area is expected
to draw up a plan each year for how it spends the money it is
allocated for drug treatment. Three years ago, local areas were
spending £50 million a year on residential rehab and residential
detox. In 2009-10 they are planning to spend £80 million,
so there is no way that the money has actually been cut back.
What we have seen is a very significant improvement in the provision
and increasingly the quality of community-based treatment. The
National Institute for Clinical Excellence, who determine these
things, say that the front line for heroin dependency is methadone
delivered in the community. They say that, for some people who
have particular problems or who have failed a number of times
in other forms of treatment, residential rehabilitation then becomes
the better option.
Q22 Mr Mitchell: You are saying that
they believe in this methadone treatment in such a way as to indicate
that you do not quite believe it?
Mr Hayes: No. Far from it. I am
merely saying that it is their job to read the evidence and conclude
what is the best intervention. I have read the same evidence and
surprisingly I have come to exactly the same conclusion.
Q23 Mr Mitchell: You said the number
of drug-related deaths has gone down and is now flat lining. Our
brief—I will cite page eight for the NAO—refers to
two figures in the Report, figure six and figure five, which do
not say the same thing. It says the number of deaths has increased.
Who is right?
Ms Murphie: The number of deaths
has increased from 2004-05 to 2008-09 but if you take a longer
timescale what Paul is saying is that it shows a decline.
Q24 Mr Mitchell: You are wrong?
Mr Hayes: No. I am absolutely
right.
Q25 Chair: Are you ever wrong?
Mr Hayes: It has been known. You
would be asking questions if I was wrong. You would want to know
what I was doing for a living, would you not? If you start back
in 1993, there were 787 drug-related deaths. It peaked in 2001
at 1,697. We did suggest to the NAO that they started the graph
at 2001 but they would not have that. Since then, what we had
for the first couple of years was a decline. It has gradually
been edging up but it still has not got back to the 2001 figure.
What we believe has happened is, since treatment has expanded,
the international literature again identifies access to methadone
treatment as the most effective way to restrict the number of
drug-related deaths that are taking place. Since we began to expand
treatment, the trajectory has very much been reversed and our
view is that if we had not expanded treatment in 2001 there would
now be something like 2,500 drug-related, overdose deaths every
year rather than the 1,600 that there are.
Q26 Mr Mitchell: We are spending
£1.2 billion a year tackling drug use. Problem drug use is
estimated to cost £15.3 billion. £13.9 billion of that
is the estimated cost of drug-related crime. Is there any way
of indicating that, as the expenditure has gone up, drug-related
crime has gone down?
Sir David Normington: It is undoubtedly
the case that acquisitive crime, which is burglary and theft mainly
and other similar things like shoplifting and so on—
Q27 Mr Mitchell: To pay for a drug
habit?
Sir David Normington: Yes, to
pay for a drug habit. That has declined by 32% since 2003 when
we introduced the Drug Interventions Programme, which required
people to be tested when they went into the criminal justice system.
In parallel, the amount of treatment was increased. I cannot prove
an absolute causal link but it is a fair bet that since our interventions
have reduced offending and reoffending for problem drug users
that has been a contributory factor to the decline in acquisitive
crime.
Q28 Mr Mitchell: Does that produce
a return?
Sir David Normington: Yes, there
is a good return.
Q29 Mr Mitchell: Can we turn to figure
six on page 26, which has been slightly revised in terms of essentially
problem drug users? Is it possible to produce those figures on
a more local basis? We have instanced Lincolnshire and, in my
case, North East Lincolnshire. Is it possible to give us the figures
on a local authority basis?
Mr Hayes: It is possible to reduce
it down to a partnership basis, which would mostly be a first
tier local authority.
Q30 Mr Mitchell: Could you do that
for my area?
Mr Hayes: Yes. We can do that
for everything other than the last three.
Q31 Mr Mitchell: Thank you. I would
like that. There is a category here: the number of problem drug
users leaving treatment free of dependency, which is defined in
a footnote, and the number of drug users leaving treatment free
from illegal drug use. Is that also weaned from any drug dependency?
Are these people on methadone?
Mr Hayes: No. People who are on
methadone would be regarded as still being in treatment. They
have completed their treatment; they are not on methadone; they
are not receiving any sort of counselling interventions at all.
They have left the treatment system.
Q32 Mr Mitchell: You are being successful
there?
Mr Hayes: We would argue we are
being successful most of the time. It is important that we recognise,
as I said earlier, one of the things that the public find difficult
to grasp is that the real benefit for them from treatment flows
not from people leaving treatment having overcome addiction—although
that is clearly what we want to do with everybody—the real
benefit flows from people being held stable in treatment when
their health improves, the risks they pose to others through crime
and public health reduces and their ability to care for their
children and earn their own living improves. It is not just the
people who leave treatment who are actually delivering the value
for money; it is the people who are being held stable in treatment.
Q33 Mr Mitchell: Do you regard methadone
treatment as successful?
Mr Hayes: I regard methadone treatment
as successful.
Q34 Mr Mitchell: Other people have
argued that before 1970, I think it was, people used to be issued
with heroin and that was the most successful way of dealing with
the issue. Can you just tell us your views on that, because I
get very confused by this debate?
Mr Hayes: There is a trial. The
first thing is we still do that. There is still a small number
of people in this country who are prescribed diamorphine, which
is pharmaceutical heroin, and have been since the 1920s.
Q35 Mr Mitchell: You say "small".
How many?
Mr Hayes: A few hundred. There
have been trials in London, Brighton and Darlington of set clinics
where people will attend every day to receive an injection of
diamorphine. What that has demonstrated is that if you get the
right people into that treatment—i.e., the people who have
not benefited from other forms of treatment—then it can
be cost-effective, but the number of people who will not benefit
either from methadone or residential rehabilitation who need that
treatment is actually very, very small indeed.
Q36 Mr Mitchell: I am glad to hear
that. Just one final question on that table. The number of people
leaving treatment who do not need treatment any longer and the
number of people free from illegal drug use is rising and that
is good. The number of people going through it is also rising.
Is there any social breakdown of the social class or occupational
class of these people? One gets an image from the media that Notting
Hill is thronging with people snorting cocaine and that the pop
world is full of people also snorting cocaine and doing it comparatively
immune from arrest and trial. For those people who have to come
to treatment, who are convicted of a crime or whatever, is this
a culture of despair as opposed to an upper class culture of entertainment?
Sir David Normington: Those people
who are using powder cocaine would not be in that table I think
I am right in saying.
Q37 Mr Mitchell: Why?
Sir David Normington: Because
this is a table of what is in my view slightly unfortunately called
"problem drug use".
Q38 Mr Mitchell: If I am posh I do
not get in there?
Sir David Normington: This Report
is about opiates. That is mainly heroin and crack cocaine. It
is not about powder cocaine, though the Drug Strategy overall
is about all drugs, including powder cocaine. What you are talking
about is people who snort powder cocaine. Some of the media stories
about the type of people who do it are very prevalent at the moment.
There is some evidence of a slight increase in people using powder
cocaine. They are over quite a wide range of social classes but,
of course, the people who get into the press tend to be the people
you describe.
Q39 Mr Mitchell: They do not come
into contact with this treatment unless they commit an offence.
Sir David Normington: All we are
talking about is they are not in that table. Drug treatment is
available for them increasingly and, of course, if they go into
the criminal justice system they are tested and if they are tested
positive then they are assessed and hopefully directed to treatment.
It is just that they are not in those figures.
Q40 Mr Mitchell: Are you saying that
powder cocaine or whatever does not create dependency in the same
way?
Sir David Normington: It can do,
yes.
Mr Hayes: It absolutely does.
It creates dependency, it causes ill health and quite a few deaths.
There is no way that it is not dangerous, but there is a different
demographic around powder cocaine and heroin and crack. As I said
earlier, the people who will tend to use heroin and crack are
the people who struggle with life most. They live in our poorest
and most disadvantaged communities. That is where they congregate.
It is also where it is easiest to get hold of heroin and crack.
That does not necessarily cause all their problems, but what it
does do is make it much more difficult for them to resolve the
other problems in their lives. A cycle of despair, as you called
it earlier, I think is an entirely legitimate way of describing
it.
Sir David Normington: If I may
add one thing, most of the crime that is drug related, which is
described in this Report, is related to heroin and crack cocaine
and not as much to powder cocaine. That is why this is concentrating
on that because the costs to society are very substantially in
relation to crime. People who take powder cocaine are indeed committing
a crime themselves but they do not generally to any degree feed
their habit through crime.
Q41 Mr Mitchell: I am interested
to hear that. I spent 10 days in a council flat in Hull and it
was quite horrifying. There is a culture of despair of kids—and
they were kids—injecting themselves in the stairwells at
night, ringing every doorbell to get in, including mine. My reply
was less than polite. They are leaving needles all over the place.
It was quite horrible. Do you have figures on the social background
of the 42,000 people who have gone through?
Sir David Normington: We do not.
The sort of people you are describing are people who are in the
most deprived communities. They are the most deprived people in
society. Most of them are on benefit. They are not in work. They
are the people completely at the bottom of the heap. We do not
have a socio-economic breakdown of them.
Q42 Mr Mitchell: As long as they
do not commit a crime, you will never catch up with them.
Mr Hayes: No, that is not true.
75% of them access treatment voluntarily. Only 25% access treatment
through the criminal justice system.
Mr Mitchell: I am sorry, the questioning
seems to have become addictive for me. I have overrun my time.
Q43 Mr Davidson: Can I just come
back to this question of the profile of users? As I understand
it, a high percentage—I am not quite sure which percentage—of
the people who are taking these substances are basically poor,
badly educated, in a culture of despair and all the rest of it,
but there are more people in those circumstances than end up as
drug users. I am not clear what the determinants are that decide
whether or not somebody goes down one route as distinct from another.
Is there something that we can learn from that in terms of prevention?
Mr Hayes: I think it is a very
astute question and I wish I knew the answer to it. We could ask
similar questions around offending. We know that offending is
associated with all those demographic factors. We also know that
most poor people, most working class people, do not offend. It
is a similar issue.
Q44 Mr Davidson: I am just interested
in where this takes us forward, in a sense. We know, in terms
of profiling, most senior civil servants are public school and
Oxbridge but not everybody from public school and Oxbridge ends
up being a senior civil servant and vice versa. I understand you
are a grammar school boy, yes, I know that, but in terms of your
colleagues. It is just a question of whether or not in terms of
prevention there is anything you have come across that provides
us with guidance and whether or not there are preventative measures
that would be value for money in terms of avoiding the enormous
costs that are incurred further down the road.
Mr Hayes: This Report does not
deal with prevention.
Q45 Mr Davidson: No, but you are
here.
Mr Hayes: I am here, but my agency
does not deal with prevention. One of the subjects on which I
am not always right is prevention.
Sir David Normington: One has
to be careful because everything one says here tends to create
broad categories. Basically, your chances are poorer if you are
in some kind of broken family, if you do not have family support.
That is why in the new Strategy that we have launched there is
a big emphasis on trying to treat drug abuse within families,
because often it is passed on from parents to children and that
is where they leave it. If your father is an offender, then it
is quite possible that you might become an offender. If your father
is a drug user, it is possible you will become a drug user. It
is not invariably the case, but what we have at the moment is
it being passed on from generation to generation. That is why
some of the things that we are doing with families are the most
important things that we are doing in the social policy field.
Q46 Mr Davidson: The cost to society
of problem drug use is estimated at £15.3 billion a year.
£13.9 billion is the estimated cost of crime and related
matters. Am I right in thinking that the vast majority of that
is poor people on drugs stealing from poor people who are not
on drugs? They do not actually go off and rob the big houses;
they go and rob the neighbours and the neighbours' cars and all
the rest of it. That is what I thought. Would it not simply be
cheaper in economic terms to give them all free drugs, leaving
aside the point I understand you were making earlier on about
treatment and only a small proportion for whom that is deemed
appropriate? That is in terms of the users' difficulties but in
terms of their neighbours' difficulties, the people I represent
by and large, they would like to have this crime stopped. Have
you considered giving them free drugs as a means of cutting crime
in order to make everybody else's lives better?
Sir David Normington: There are
those who think that should happen. That, of course, is absolutely
not the Government's policy. I think it is a sort of counsel of
despair because it does not take you anywhere. It means that you
leave these people on drugs forever.
Q47 Mr Davidson: It is not a counsel
of despair for the people who are living beside them, whose houses
are getting broken into, with respect.
Sir David Normington: No, but
the evidence is that if you put them into treatment and in some
cases give them alternatives to illegal drugs, like methadone,
actually that will stabilise them. We have some evidence here
that through treatment of various sorts you can stabilise them
and protect their neighbours. That, therefore, is a benefit to
them and their families as well as to their next-door neighbours.
Q48 Mr Davidson: There is a relatively
small number being given both methadone and diamorphine. Are they
continuing to commit offences?
Sir David Normington: Some.
Mr Hayes: Some of them are. Overall,
it is a 50% reduction in offending.
Q49 Mr Davidson: Is that greater
than the proportion of those who are either untreated or undertaking
other treatments?
Mr Hayes: Significantly so. The
comparison is what would happen untreated and what would happen
treated. Treated, offending halves.
Q50 Mr Davidson: If they are treated
simply by being given free drugs?
Mr Hayes: In a sense, some people
would argue that prescribing methadone is exactly that and will
have that effect. We know if we can get them scripted a big chunk
of them, about half of them more or less, will stop committing
offences entirely, another proportion will reduce their offences
and for some it will make no difference. Over the entire population
it comes out at around about a 50% reduction. Your community,
your voters, are already deriving that benefit. One of the difficulties
though is that most people come into treatment actually want to
get clean. They want to get off drugs in the end. If we just said
to them, "We will give you drugs forever", we would
not only be saying that what might be a relatively short period
of time on drugs—for some people it might last 20 years;
for others, it might only last a shorter time—we are actually
condemning them to stay drug dependent for the rest of their lives.
We are also condemning their children and depriving the rest of
the community of the potential of their productive efforts and
the taxes that they can pay if we can turn them round.
Q51 Mr Davidson: Up to a point I
agree with that. I am reminded of the joke about how many social
workers does it take to change a light bulb. Only one, but the
light bulb has to want to change. The context is if you are putting
people into this sort of treatment and they do not want to change,
then it is clear, as I see in my own constituency, that it is
not successful. People will go into drug treatments because the
sheriff or the court or somebody else tells them they have to
do it and they have not the slightest intention of going down
that road. What I want to clarify is whether or not the wanting
to change element can be genuinely identified as distinct from
those who are having to do it. I would have thought that might
actually be quite difficult in a sense because people who are
users will lie repeatedly and convincingly about a whole number
of things, like alcoholics. It is very difficult then to distinguish
between who is genuine and who is not.
Mr Hayes: Surprisingly, there
is no evidence that people who are coerced into treatment do any
less well than people who have entered treatment on a voluntary
basis. One of the things that is surprising is that for an awful
lot of people who apparently enter on a voluntary basis, their
mothers had their arms twisted up their backs, their spouse is
putting pressure on them, their employer is putting pressure on
them. The reality is that offenders do just as well in treatment
as non-offenders.
Q52 Mr Davidson: That is distinguishing
offenders from non-offenders. The category I was trying to identify
was, as it were, those who genuinely want to as distinct from
those who are quite happy.
Sir David Normington: We know—and,
indeed, the Chairman said this earlier—that in the figures
there are over a quarter of people who get into the Drug Interventions
Programme who then go on not only to offend but to increase their
offending. There are people for whom this programme initially
and perhaps for some time simply does not work. They are the category
of people we are talking about, I think, the people who just do
not want to be treated and to get off drugs.
Mr Hayes: At that time.
Q53 Mr Davidson: That is right. I
think that is an important point. I keep coming across people
who lapse back and clearly are just going through this because
they have been instructed to go through hoops. There is no genuine
intention. It is in that context that I want to pick up the point
about residential as distinct from community care. Lots of the
youngsters that I come across will tell me that they find it very
difficult to break from drugs because they are doing some treatment
and then they are running with the same pals who have not been
put into this context and, therefore, the peer pressure is all
about involving themselves in that sort of culture again, being
involved in crime because their pals are doing it. Surely the
Chairman did have a point in terms of taking people out of those
sorts of circumstances until they feel sufficiently strongly motivated
to stay out of it is actually helpful.
Mr Hayes: It can be, but the trade
off is the re-entry is then doubly difficult. What we have found
over many years—the Americans have found the same thing—is
if you take people out of the community they still have to go
back there. They are then going back there in a situation where
they perhaps have lost their social support. Over time, what is
now beginning to happen is a new type of residential facility
is beginning to be established that is not located at the seaside
or in the big house in the country, it is located in Warrington,
Liverpool or Luton, connected to their local treatment system,
connected to local mutual aid organisations like Narcotics Anonymous
or Alcoholics Anonymous et cetera, where you are able to build
a ready route back into support systems, back to their family,
because they are actually doing it within that community. That
appears to be delivering the goods for us.
Sir David Normington: Let me just
make one point because this keeps coming up. The pattern of drug
taking and other substance abuse for young kids is completely
different from that of young adults. Therefore, the treatment
that you need and the support you need to give them is completely
different. A lot of what I think we were talking about earlier
with the Chairman was about how you treat the under 18s who might
be abusing alcohol, smoking a bit of cannabis, sniffing substances
and so on, and also who have all sorts of problems in their community.
They are probably truanting from school. They are probably in
and out of their family and so on. The treatment that they need,
because that is a risk-taking group, is different on the whole
from the treatment that people who are adults need. They are the
ones who are more likely to get into addiction and to take more
serious drugs. On the whole, young kids do not take the heroin,
they do not take crack cocaine, that is not the pattern. You have
to treat young people differently and actually it is better if
you treat them at home, near home or in the community in the way
that Paul Hayes is describing. You are right, though, peer pressure,
the pressure from their friends, is one of the absolute keys here
and that is one of the problems.
Q54 Mr Davidson: To what extent in
drug use amongst the young is there a comparison to be made with
youth offending? The police locally will often tell me that the
best thing that happens to reduce offending is ageing, they just
move on. To what extent are people changing and deciding they
want to break the habit just simply because they age as distinct
from seeing the light? Is it something, therefore, where you would
be as well almost not bothering spending any money on because
you will have a disproportionately high failure rate until they
get to a certain age when they start seeing that other perspectives
are open to them?
Sir David Normington: Most teenagers
who commit crimes do not go on and commit crimes in adulthood
in fact, so in one way you are right, but actually, of course,
you do not know which they are going to be. The other way of looking
at this is that by giving them various kinds of support, giving
them education about the dangers of drug use at school and so
on through some of our campaigns, does have a beneficial effect
because you do not know which of those kids are going to go on
and become the habitual criminals when they get older.
Q55 Mr Davidson: It was suggested
to me earlier on when I said to somebody I was coming to this
that they reckoned that in fact more young people stopped using
drugs as a result of death than as a result of treatment. Is that
correct?
Sir David Normington: I do not
think so.
Q56 Mr Davidson: I am aware in my
community there are quite a number of regular deaths that people
know about. You obviously do not hear as much about people giving
up and I just wondered if that was the case.
Sir David Normington: There are
some terrible instances of deaths among young teenagers but on
the whole it is very, very rare. The really encouraging thing
is that drug use amongst young people has been in steady decline
over the last 10 years.
Mr Hayes: The number of under-18s
who complete treatment free of dependency is significantly higher
than adults.
Q57 Mr Davidson: The final point
I want to make relates to the point that was made by my colleague
about Notting Hill and related matters and the question of role
models. Is there any evidence that many of these youngsters from
poor backgrounds would just go down the road of drugs anyway,
or is there evidence that pop stars, footballers and people in
high, prominent positions being involved in drug use have acted
as role models and served to make it more respectable and, therefore,
ought we to be trying to crack down on them much more to make
it clear that society disapproves?
Sir David Normington: I think
I am right in saying—you may correct me on this—that
surprisingly perhaps young people are not really influenced by
celebrities. That is the evidence. They are not as influenced
as one would think, particularly in relation to drug taking. That
is not what causes them to take them and that is not, on the whole,
what causes them to stop.
Q58 Chair: Ms Mandie Campbell, I
am conscious you have not been allowed to say anything yet, but
you have had quite a lot of competition. You are the director
of the Drugs Partnership. You are obviously into cross-government
initiatives. Would you like to comment? How do you justify what
has been achieved to the taxpayer? Is it the most effective thing
we could be doing?
Ms Campbell: I think that we have
lots of evidence to show, as my colleagues have described, a really
positive return on investment for the very big spends in the Drug
Strategy, so those areas of drug treatment and of the Drug Interventions
Programme. We work very closely with colleagues from across the
whole of Government, from many different departments, but also
with the voluntary and community sector, to help drive down problem
drug use.
Q59 Chair: How are you focusing across
Whitehall on making people pool resources, pool knowledge, make
sure there is collective delivery, all these sorts of factors,
and that we are evaluating things comprehensively? What are you
doing about this?
Ms Campbell: I chair a cross-government
group that brings together people from many different departments
and there are obviously sub-structures to that. We meet regularly
to discuss a range of issues relating to the Drug Strategy to
ensure the value for money spend that is required of us, but also
to look at how we can be more creative, more innovative, how we
can evaluate those areas that are new areas, as the Report illustrates,
and we perhaps do not have sufficient evaluation for yet; and
to make sure that we are continually trying new ways of ensuring
that we are getting the best possible value for money.
Q60 Chair: So if you come back to
this Committee in a couple of years' time we will have this overall
evaluation at a more sophisticated level, will we? Remember that
was the very first question I asked Sir David and he said, "We
are doing it individually but we are not doing it comprehensively".
This is your job, so you are going to be working with us now and
you will be able to report back to us within a couple of years,
will you?
Ms Campbell: Yes, I will. We have
agreed with the National Audit Office that we will put a framework
for evaluation in place that will look to identify and address
those areas that are not evaluated at the moment.
Q61 Chair: Are you going to be allowed
to stay in position or will Sir David promote you to another position
within five minutes? Will you actually get a grip on this and
be here for another two or three years, you personally?
Sir David Normington: I should
not announce your promotion here, should I?
Ms Campbell: That is absolutely
fine if you would like to!
Sir David Normington: I am in
favour of leaving people in jobs so that they can see through
what they have started.
Chair: Thank you, very good.
Q62 Keith Hill: Perhaps I could begin
with Sir David. Do we have any notion about how many problem drug
users there are currently?
Sir David Normington: The best
figure we have is in the Report, which is 330,000. You can see
why it is difficult to be certain about that but the result of
what we have been doing is that we are in contact with more of
them, therefore we know more about them. We are not just relying
on what we did years ago, which was the self-declaring of a problem,
which obviously is unreliable.
Q63 Keith Hill: How does that 330,000
approximately compare with the position at the start date of the
Drugs Intervention Programme?
Sir David Normington: I do not
know that I have that figure. Do you have that figure?
Ms Campbell: It was a much smaller
number.
Sir David Normington: It was a
much smaller number. What has happened in this strategy is that
we have just worked harder at identifying them and counting them,
so any other figure that we give for the past is not a reliable
figure from our point of view. We think that problem drug use
is stable. It goes up and down slightly. It has been just slightly
nudged up by powder cocaine at the moment, class A drug uses,
but the problem drug users figure has been coming down a bit,
we think, although the figures are very unreliable. Some years
ago we relied on people self-declaring in our surveys and, of
course, this group does not self-declare.
Q64 Keith Hill: I understand the
qualifications you made, but, forgive me, I did not quite pick
up the exchange between you and Mandie Campbell. Did I pick up
that you were suggesting that the figure might have been lower
at the beginning of the programme?
Sir David Normington: Yes.
Ms Campbell: The figure was significantly
lower because, as my colleague explained, it was because at that
point we did not have a number of the programmes running that
we now have running that enable us to give a much more accurate
estimate of the numbers of people who have problem drug use. The
counting that we are now able to do of all the numbers of people
who come into the treatment system and those who have come into
the system through the Drugs Intervention Programme, which only
started in 2003, enables us to give a much closer estimate of
the numbers than was possible before.
Q65 Keith Hill: How many people do
come into the treatment programme new each year?
Ms Campbell: Currently around
4,800 people per month come through the Drugs Intervention Programme,
so last year there were around 237,000 people who came through
the programme into the caseload.
Q66 Keith Hill: I know this is a
different question, but do we have any notion as to how many new
problem drug users there are each year?
Ms Campbell: I am afraid that
is not something that I would be able to answer now. I do not
know if my colleague, Paul Hayes, is able to answer that.
Mr Hayes: The Home Office asked
the University of Glasgow to look at this and they did a study
over three years, I think it was, and it came out at 320,000-330,000
each year, so we have reason to believe that it is at worst stable,
the number of problem drug users. The Drugs Intervention Programme
is only one of the routes into treatment. About 80,000 people
come into treatment each year and about 60,000 leave. There are
some indications which are making us reasonably positive and optimistic
that when we receive the next work from the University of Glasgow,
which looks at the prevalence estimates, we might see a reduction,
and I emphasise "might". As has already been said, the
number of people using cannabis, amphetamines, LSD is falling.
The number of under-18s coming into treatment with heroin or crack
problems was 1,000 three years ago; this year it is 600. Similarly,
the number of 18-24s is down 20%. We are beginning to see a reduction
in the number of under-30s accessing treatment at a time when
treatment has never been more available, so that gives us some
optimism that there are fewer of them there. We will not know
for certain until we see the Glasgow numbers.
Q67 Keith Hill: That is good to hear.
Was I right in making a note that you said last year 15,000 people
left the programme free of drugs?
Mr Hayes: Free of dependency,
yes, the problem drug users.
Q68 Keith Hill: That implied, therefore,
if the figure is stable, that maybe about 15,000 new problem drug
users are identified each year?
Mr Hayes: No, it is a little bit
more complicated than that. Across the whole population some people
will complete treatment successfully, some people will drop out
early, some of those who complete treatment successfully will
relapse subsequently, some of those who drop out will relapse
very quickly and come back into treatment, some of them will manage
never to come back into treatment. We have a constant flow of
people leaving for good reasons, people leaving for bad reasons,
people rejoining in the current year and people rejoining in subsequent
years. It is a complex flow and stock situation, but in total,
over the last five years, on average 80,000 new people have come
into the treatment system, 60,000 other people have left, both
for good or bad reasons, and the treatment system has been growing.
Q69 Keith Hill: I think, also, you
said that your statistics indicated that 125,000 people have been
through treatment and had not shown up again subsequently in the
criminal justice system.
Mr Hayes: Or in the treatment
system.
Q70 Keith Hill: But that does not
mean that those people still do not have a drug issue, does it,
and I am talking about a problem drug issue?
Mr Hayes: We cannot know that
for certain. One of the difficulties is that, particularly with
this population, we cannot track them. We can track them whilst
they are in treatment. What we cannot do is track them with any
absolute accuracy after they leave treatment. What we have developed,
together with colleagues in the Home Office and elsewhere in Government,
is the ability to look at the various data sets: have they come
back into treatment, have they died, are they in prison, have
they been arrested, are they in a psychiatric hospital somewhere,
so we can then get a handle on what is happening to them and what
is happening with their lives.
Q71 Keith Hill: What do you think
is happening to them?
Mr Hayes: What we think is happening
are two things. As I say, 25,000 people left last year, having
overcome dependency; about two-thirds of them do not come back,
a third relapse and come back. About another half of the people
who left come back, most of them very quickly. The other half
we know from long-term studies actually manage a drug-free life.
One of the things that happens is that people do not leave treatment
in a bureaucratically neat way. They decide that they have had
enough of it and they go off and get on with the rest of their
lives. One of the things that signals when someone is ready to
leave treatment is that they begin to leave the addict identity
behind them, so therefore we cannot guarantee, particularly with
the clientele that we are working with, they will arrive for their
last appointment and sign a bit of paper that says, "I am
now clean. Can I leave, please?"
Q72 Keith Hill: One of the concepts
that I am genuinely trying to understand, because I think it is
probably very important in your approach, is this concept of people
being held stable in treatment. You have talked about that already
but could you explain a little bit more about that concept?
Mr Hayes: There are two issues
there. The first is that we know—and the reason that the
international evidence is so strong about methadone and accepted
in most western countries, including the USA—that it can
immediately give people a stable life back, a life where they
can care for themselves, where they do not have to offend, where
they can look after their children better, they can even seek
employment. It is not an ideal life and it would be much better
to have passed through treatment and left it behind, but it does
give people a platform from which they can then go on and improve
other things about their lives. The other thing we know is that
what the academics call the treatment dose accumulates over time.
If someone is in treatment just for a few weeks the probability
is that it does them no good. If they are in treatment for 12
weeks or longer then the odds are that the next time they come
back, even if they relapse, they will be in for longer still,
and the time after that it will be even longer, and the time after
that they will go all the way. Every time you can get someone
in for treatment for 12 weeks or longer that is the biting point,
if you like, at which long-term change begins to accrue. The longer
we can hold people in, both the less harm they are doing to themselves
and others but also the more likely it is that the benefits of
treatment will accrue over time and they will eventually leave.
Q73 Keith Hill: What is the nature
of the treatment they are receiving?
Mr Hayes: The nature of the treatment
they are receiving depends on the drugs they are using. If they
are using just stimulant drugs then the treatment will be counselling,
psychosocial interventions, behavioural therapy, et cetera, and
they are very effective. The results we have had around powder
cocaine that I mentioned earlier are impressive. For opiate users,
which is the majority of people in treatment, in addition to those
therapies they receive substitute drugs—methadone, buprenorphine—that
enable them to be stable and then benefit from the psychosocial
interventions that they are receiving. What is certainly true
is that the system in many places is not as good at delivering
the psychosocial interventions as it is at dispensing methadone,
and one of the challenges for us is to make sure that the change
effort within the system is as effective as the stabilisation
effort.
Q74 Keith Hill: Can I ask you briefly
about prisons, because I think Sir David said that we were getting
better at keeping people in treatment while they are in prison
and meeting them at the prison gate, and yet, notoriously, our
prisons are said to be—and the word that was used was—awash
with drugs. How do these things fit together? Is there not a risk
of contradiction that we are seeing here?
Sir David Normington: I think
the figures I quoted were that drug use among prisoners has come
down from about a quarter of prisoners to just under 8%[3]
over quite a short period, in the last three, four or five years,
and that suggests that two things are happening. One is that the
effort prisons are making to stop the smuggling of drugs into
prisons is beginning to have some effect. In fact, the Ministry
of Justice have just had a review of that work and have increased
their screening and so on both of their staff as well as of visitors,
so that seems to be having some effect, but also fairly recently
treatment in prisons has been getting better. There is now a programme
which is generally overseen by clinicians, by medical staff, and
as long as you can (and this is a problem that your other Report
deals with) provide a stable period for people so that they can
have the treatment over a period in the same place and they are
not being moved around, you have some really good results coming
out for prisoners being treated and, in the same way as we are
describing for other sorts of treatment, having benefits from
that. There are all sorts of additional problems that prisoners
have when they come out of prison about the re-integration back
into the community.
Q75 Keith Hill: How good are we at
meeting people at the prison gate? Let me give you a little bit
of illustration. I have Brixton Prison in my constituency. Classically,
what people say is that they come out of Jebb Avenue, which is
where the prison is located, they turn left to go down to the
Jobcentre in Brixton, but the problem is that they know where
the crack houses are en route and there is a risk that
they will walk into those and, Bob's your uncle, they are back
on the old routine. We need to be good, do we not, at meeting
people at the prison gate?
Sir David Normington: I would
like Mandie Campbell to take this because in the 2008 strategy
this is what we have begun to move onto. We have to be good in
exactly the way you describe. We cannot have people being treated
and then falling off the edge, walking down the street and going
into the crack house. That is what has happened. We cannot have
that. That is what we are trying to tackle.
Ms Campbell: Absolutely. That
type of approach is a key part of the Drugs Intervention Programme
and what we are doing through that programme is trying to build
that "meet at the gate" process. Now in our DIP-intensive
areas where we have most of our resources around the country we
have about 80%[4]
coverage of people being met from the gates of prisons by drug
key workers and then taken into assessment and treatment so that
they do not do exactly as you say, which is go via their ability
to get their illegal drugs. We have worked with colleagues in
the Ministry of Justice to produce very robust guidance for staff
in prisons and in the community so that we have that continuity
of care which comes from being in prison right through to ensuring
that they are met at the gate, taken out and helped then to integrate
back into society. I would like also, in relation to the Drugs
Intervention Programme, just to clarify the figures. In relation
to the 237,000, that is the number of people who were tested last
year under the Drugs Intervention Programme, and of those around
57,000 then went into treatment. I just wanted to make that absolutely
clear.
Keith Hill: Thanks for that.
Q76 Chair: Sir David, thank you.
It has been a very interesting inquiry and I think that concludes
it. I have a very last question and you can use it to sum up.
It has been said many times that we are paying as a taxpayer £1.2
billion a year on a range of initiatives and it is costing society
£15 billion a year, so when do you think it would be appropriate,
Sir David, for us to have you back with Mandie Campbell, and hopefully
Mr Hayes as well, to see what progress you have made, particularly
on this thing that I think worries us perhaps most of all, that
for a quarter on the programme there is no change in their criminal
activity and for a quarter they commit more crime? When do you
think we can have a positive inquiry, because the whole point
of this is not just to have a debating society or try and embarrass
you; it is actually to make progress, so how can we help you in
your efforts?
Sir David Normington: We have
had a bit of an exchange about this. We think in relation to this
strategy in three-year chunks, so I think it will be late in 2011
or early in 2012, around that time, when we ought to have the
evidence that you are asking for.
Q77 Chair: Thank you very much, Sir
David.
Sir David Normington: May I say,
Mr Leigh, that you and I have been adversaries over nine years,
I think. I just want to say thank you very much for your courtesy
and we wish you well.
Chair: Thank you. It has been very enjoyable.
1 Note by witness: The testing for Class A drugs
(heroin/cocaine and crack cocaine) takes place in 173 police custody
suites around the country. Back
2
Note by witness: The random mandatory drug testing (rMDT)
programme which is the best measure of drug misuse in prisons
has dropped from 24.4% in 1996-97 to 7% in 2008-09. Back
3
Note by witness: The random mandatory drug testing (rMDT)
programme which is the best measure of drug misuse in prisons
has dropped from 24.4% in 1996-97 to 7.7% in 2008-09. Back
4
Note by witness: The figure relates to DIP research undertaken
in May 2009 which showed that over 80% of intensive DIP areas
provided a "meet and greet" from prison where this was
considered necessary. Back
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