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4.54 p.m.

Baroness Masham of Ilton: My Lords, because of the concern at the increase of drug abuse, I put down an Unstarred Question for Wednesday 19th October which asked the Government what they were doing about it. As several noble Lords wished to speak, I must apologise if any confusion was caused. The debate was delayed because the Government wanted to make a Statement. They then brought out their important Green Paper Tackling Drugs Together. What was an Unstarred Question on the subject has now grown into a major government debate with two Ministers speaking. I should like to say how grateful are the organisations involved for the interest shown and the encouragement given by the Minister, the noble Baroness, Lady Cumberlege, who attends many meetings with them, especially on AIDS.

Up and down the country encouragement is being given to HIV and AIDS awareness, and 1st December has become known as World AIDS Day. Drug abuse and AIDS are world problems. It is with great sadness that I remember today several people who died too

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young because of those two enormous disasters which cause so much heartbreak and anguish to families and friends across the world.

Drugs penetrate into homes, universities, schools, pubs, clubs, prisons, sports organisations, airports, railway stations and many other places. Drugs have penetrated all kinds of communities within inner cities, market towns and rural areas. The purchasing, providing and marketing is done as skilfully as in any successful business. The result to society, without doubt--I am sure that the Minister will agree with me when she sums up--is that the trade in illegal drugs has increased the amount of serious crime committed. We knew that crack would be a real danger. Our worst fears have been realised. The spread of crack has increased the amount of violence used and the carrying of guns. I ask the Minister, the noble Baroness, Lady Blatch, what suggestions the Government have for tackling seriously the problem of crack.

As many noble Lords will know, crack comes in small rocks of pure cocaine. It is smoked rather than snorted. As the drug travels directly from the lungs to the brain, its effect is more powerful. As a result of its immediate impact on the brain, all its effects are magnified. The "rush" is intense. The individual enjoys less than 15 minutes of intense rapture, exultation, confidence and feelings of well being. However, the intensity of the "rush" appears to speed up the rate of dependency. Once dependent, the user uses the drug not to feel good but to avoid the crash--the inevitable depression.

The implication for an addict's health are enormous. Most seriously affected are the respiratory system in respect of which it causes chronic bronchitis and the cardiovascular system in respect of which it causes irregular heart contractions, increases blood pressure and results ultimately in heart attacks. Other complications include depression, anxiety, epilepsy or seizures. Further problems are caused to pregnant users.

With so many law and order implications associated with the drug trade, I was surprised yesterday to read that many jobs in the Customs and Excise are being cut. I should like to congratulate the staff of Customs and Excise on their recent big drug hauls. I am sure that the Government's answer will be that most of the work is done by undercover work. However, it seems that a combination of many people working together--for instance, undercover police and customs officers--with the public and government departments giving support, is the answer. Detection and success in finding the drugs is such a difficult and skilled job. With so much deregulation, will this not make Britain more vulnerable to the drugs trade?

This year I visited two prisons where drug initiatives in rehabilitation are going on. I am sure that the treatment and rehabilitation of prisoners addicted to drugs is worthwhile. We all know that, as with alcoholics, it does not always work. One prisoner told me that he had re-offended within 24 hours of leaving prison and had planned his first job before going out.

Drug dealing within prison is very dangerous. Prisoners can get into debt and the drug barons will have systems of threatening the families outside if they do

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not pay. If needles are circulating in a prison the prisoners will be at risk from HIV. The prisoners will have mood swings and paranoia, and can be violent. I have always believed that as regards any form of health education prisoners are a captive audience and it is time well spent. If they learn something useful it may help their families and friends when they are released. We have heard that urine testing will take place in prisons. I very much hope that along with it will be treatment. Without treatment there can be violence, as has been seen in some prisons, and riots should be avoided at all costs.

I see hope, and I hope that the Minister will tell the House that treatment and rehabilitation will be increased throughout the prison service. As Turning Point stated:

    "There is no quick fix to drug policy. The misuse of drugs is the outcome of a whole range of social factors. There is no one approach that will work to prevent or cure every individual; only harm comes from claims that one treatment is the only correct one".

Surely, the wise procedure should be to find a policy that will determine an effective balance between the control of drugs and prevention and treatment. Every community needs to understand the particular nature of the drug problem in its area and to create a range of services to deal with that.

Phoenix House is an organisation which deals with several rehabilitation houses for drug abuse throughout the country. I chaired the organisation for several years and saw the important work that it did with serious drug users. As well as catering for individuals in the community, it works as an alternative to prison. In recent years it has set up some family units so that children are not separated from their parents. The National Health Service and Community Care Act has meant that it can now offer only shorter programmes to clients because of local authorities' unwillingness or inability to pay for anything else.

I would like to give your Lordships an example of the administration difficulties encountered by homes such as Phoenix House. Phoenix House has to contract with approximately 80 per cent. of the local authorities in England. All this is done on the basis of individual contracts for each service user. Each service user's contract may involve contributions from up to three or four different parties; for instance, health money, probation money and social services money from different sections within the department. The main impact that this has had upon them has been to make critical the issue of cash flow in view of the fact that over 55 per cent. of their income is now dependent on this source. They are extremely concerned that a number of local authorities are saying that their community care money has run out. At least two of the local authorities which have publicly announced this are major referers to Phoenix House services and there has been no public or media discussion about the impact of this on drug and alcohol service providers. They have ample evidence to suggest that decisions to fund people are as finance-led as they are needs-led and that there is great pressure on officers within social service departments to keep the purchasing of residential care for their client group as low as possible.

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Some local authorities continue to be slapdash in their approach to care management, and Phoenix House experiences difficulty in getting them to take a full part in the review of a client's progress. In one instance, funding was withdrawn from somebody despite repeated requests from Phoenix House to the local authority concerned to attend care reviews. There was no response to our requests and no involvement by the relevant social services department. Then an arbitrary decision was taken to withdraw funding. The client concerned consulted solicitors and the subject is a matter of judicial review at the moment. In the meantime, an injunction has been granted to the client whereby the local authority is to continue funding and has been instructed to carry out an assessment. This is not an isolated incident. If one does not have rehabilitation services there will be more chaotic people using drugs in the community.

On a positive side, some local authorities are beginning to approach funding clients very creatively. There are now instances of local authorities having funded nursery nurses at the Phoenix House Hove Family Project and aftercare for people in private-sector tenancies in order that those from Phoenix House can continue to visit and support them following their departure from the house. Both of these were previously unfundable and other initiatives are to be welcomed.

Phoenix House, with all its experience, will be very pleased to help in any way that it can with the Central Drugs Co-ordination Unit and the task force, which is looking at the effectiveness of interventions with drug users. It is vital that, if the phrase "tackling drugs together" is not just words, everybody concerned works together and that statutory bodies put aside any professional jealousies when dealing with non-governmental organisations.

Everyone in Government should be working closely with voluntary bodies as many of the people working at ground level are closest to the problems. Some have been there themselves and know the weaknesses and the ways around. They are streetwise. I should like to recommend Fountain House. It is a nursing home for people who have been or are drug users or have HIV or AIDS. The facilities are excellent. I wish only that there were such places for other groups of disabled people.

Fountain House is run by Phoenix House. Having attended its opening in the summer, when my noble kinsman was in a BUPA hospital, I found that the bathroom facilities were much superior to those provided by BUPA. It also has a friendly approach and a lovely garden. Much thought has gone into making it patient-friendly.

I hope that what people will have read in the papers and heard on the radio and television today will stop them being complacent about HIV. Prevention is so vital. The problems that exist in Africa now exist in Asia. I read the sad story of the missionary nurse who became infected through her work and is now dying of AIDS.

I would ask the Government to look at and help with the difficult problems for women who have HIV and who have AIDS. So often they are running a house and

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family and do not have people to look after them. They are the carers. Transport to enable them to reach treatment can be difficult and to travel long distances with children when one feels ill is not so easy. The Mildmay Mission Hospital now has a family unit and the London Lighthouse is considering services for women, but is finding it difficult. I hope that the Government will listen to Positively Women who understand the many problems in this area. There needs to be a choice and there needs to be flexibility.

Education is vital. Such organisations as ACET, AIDS Care Education, are doing a great deal to help. It is very important to have responsible and effective sex education in schools and colleges. ACET distributed over half a million copies of the booklet HIV, Facts for Life. Education on HIV, AIDS and drug abuse and other health problems, and a positive approach to keeping healthy, need to be available not only to students but also to parents, teachers and governors who need educating. They all need training.

Recently a girl aged about 11 gave her biology teacher a packet of white powder and said to him, "I found this in mummy's bag: I want her to stop taking drugs".

Many people in Yorkshire were shocked when they read in the Yorkshire Post last Saturday about a young couple who were found dead in the lavatory of a restaurant in Dewsbury. They had died as a result of a drugs overdose. Their young son was in the restaurant play area oblivious of the tragedy. There will not be an easy way out of this terrible problem.

I should like to mention an important point. I have heard from the health authority on which I serve that there will be total funding for some GPs. When GP fund holding is extended, it will be very dangerous if this is extended to GUM services. Patients who may have a venereal disease or who think they may have HIV need confidentiality of the highest level. There are a few GPs who do exceptional work and who do care. They, of course, should be funded for the services they provide. However, many people do not want to go to their GP for various reasons. There should be freedom of choice, and prevention of drug abuse and HIV should be paramount. I hope that the Green Paper will stimulate debate across the country. All the people working in prevention, education and treatment need encouragement. As the noble Lord, Lord Addington, said, this is a long-term process.

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