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So the noble Lord will be aware that there was a very great deal of consultation among staff and among the general public. Indeed, to my certain knowledge, the Secretary of State has met with her colleague on several occasions, not least in the past week or so, when I believe she has met him three times.
With regard to the Secretary of State for Wales, perhaps the noble Lord will read very carefully what he said. He said that he felt that services in the future should be clinically driven. We believe in that. We are carrying out these developments primarily to improve the services in London: the health service, the academic teaching and research and development. Those are clinically driven services.
With regard to the primary care money, the total investment is £400 million overall in London, but the £210 million has been allocated through the normal budget round. It is new money. It came, as it normally does, through the distribution mechanism from the Treasury.
Lord Annan: My Lords, I wonder whether the Minister was as amazed as I was when the noble Baroness, Lady JayI sympathise with some of her worriesasked for yet another full inquiry to be made at this time and said that we were coming to rushed decisions. Was the Minister not absolutely dumbfoundedperhaps dumbfounded is the wrong wordwhen the noble Lord said that there had been no consultation with Bart's?
For 30 years we have had consultations with Bart's about getting into bed with the Royal London. Would they move? No. Every attempt to have any kind of discussions even of the problem have been completely and absolutely refused by Bart's. That is in marked contrast to what has happened in other parts of London. Does the Minister agree that in north London, for example, a marriage was arranged with University College and the Middlesex and that that has now become a very happy partnership? I believe that the Royal Free, which again for years refused to talk, is now beginning to move and become part of that partnership. The same is happening in west London.
I appreciate, as I am sure does the noble Baroness, the difficulties which face Guy's. But surely that is bound up with obtaining funds for King's pre-clinical school perhaps to move ultimately to the site by London Bridge and make one of the four new multi-faculty centres.
Baroness Cumberlege: My Lords, I should very much like to thank the noble Lord, Lord Annan, who has for a very long time taken an interest in the London hospitals. As a former Vice-Chancellor of London University, clearly he has a very keen interest in them. He is quite right; we are now seeing a huge sea change throughout London. There is a different attitude among many of the London hospitals, which recognise that in world terms they have to get together, that there has to be a critical mass and that they have to be linked in with multi-faculty colleges if they are to survive and indeed lead the world. There is a change, and change is always difficult.
Clearly, St. Bartholomew's Hospital is finding the situation more difficult than most. However, I believe that these changes are the right way forward. The new campus at Guy's will not only be a centre for education in medical terms. We also propose to take there the school of nursing. It will be very closely linked with other basic sciences within the university. I believe that it will prove to be a very new form of centre for teaching. It is an exciting development. I know that others involved share that view.
Lord Cavendish of Furness: My Lords, I presume that the probation service debate will now continue. Neither the probation service nor the Prison Service is listed among my special interests. However, the treatment of alcohol and drug abuse is a field of special interest to me. In that context I put down my name to speak in this debate, which has been so ably introduced by the noble Viscount, Lord Tenby.
I should like to say a few words on the Addictive Diseases Trust. That is a charity which has pioneered the treatment of people in prison who have severe alcohol and drug addiction problems. The implications of that treatment programme beyond prison, and therefore concerning the probation service, will be self-evident.
As noble Lords will know, addiction in prison is widespread. That was emphasised in the memorable maiden speech of the right reverend Prelate. It is the nature of addiction that people can change their chosen mood-altering drug. Thus, an alcoholic can become a drug addict. Because drugs can be more easily distributed than alcohol in a supposedly secure environment, drugs in prison have become the main focus of attention. It is thought that over 50 per cent. of inmates of our prisons have chronic, and often severe addiction. In some prisons up to 80 per cent. of inmates
It goes without saying that the consequences to the community are horrifying. It is estimated that nearly half of all property crimes is drug related. The average cost of keeping someone in prison is £23,000 a year. The average length of sentence at Downview Prison, where the Addictive Diseases Trust works, is four years. Therefore, with court and police costs, the total cost to the community for a Downview inmate is over £100,000. On release from prison there is a strong chance that an inmate will re-offend if he is still addicted. The vicious circle of addiction; offending; prison, and re-offending because of continuing addiction, has to be broken. It must follow that treatment while the addict is still in prison is the most cost-effective approach to the problem.
Only last week I was invited to Downview Prison and had the privilege of seeing something of the programme in action. It is based on a similar programme that has been used successfully in prisons in the United States over the past 14 years. Where it has been used, there is evidence that re-offending rates have dropped sharply.
I must pay tribute to Mr. Jonathan Wallace who, by dint of single mindedness and conviction, founded the trust. With equal energy and determination it is administered by Michael Meakin. They and others on the small permanent staff richly earn the support of a distinguished board of trustees, eminent patrons, including the noble and learned Lord, Lord Woolf, and an ever-widening group of friends. Through the efforts of those people and the absolutely crucial support of the governor, David Lancaster, there came into existence in April 1992 the first dedicated, stand-alone, intensive addiction treatment programme at Her Majesty's Prison Downview. It has been an outstanding success. But as far as I am aware there is still no directly comparable programme operating elsewhere in the prison system, in spite of the fact that the programme has earned warm endorsement from many quarters, among them from the governor; from HM Inspector of Prisons, his Honour Judge Tumim, and most significantly in the context of this debate, from Mr. John Harding, chief probation officer of the Inner London Probation Service. He said,
The "peer" counsellors to whom Mr. Harding refers are inmates who are themselves addicts and who have come through the programme and received intensive training. Naturally, they enjoy a high level of credibility among other inmates and their involvement is central to the objective of eliminating drug culture in the prison.
Precisely because there has been an inmate-driven culture change, Downview is well on the way to becoming a drug-free prison. There is a waiting list of prisoners applying to come from other prisons; inmates from over 60 prisons have received treatment at
I am aware that in dealing with any aspect of crime, my right honourable friend the Home Secretary is not looking for soft options. I can assure him and my noble friend the Minister that this programme is anything but soft. It is precisely the same programme that 16 years ago helped me to end my own long and wretched history of alcoholism. Even at this distance, I regard it as possibly the toughest journey on which I am ever likely to embark.
In the chronic stages of addiction, a person may be said to have disintegrated, physically, mentally and spiritually. Science has yet to come up with a definition of addiction. But empirical evidence points overwhelmingly to there being much more to the story than merely the physical effect of drugs. An addict's character becomes diseased. The ADT programme addresses this. The moving life stories we heard last week from three addicted inmates, whose careers had been a litany of crime, much of it violent, demonstrated the degree to which someone can change in a short time. The prison officers who had responsibility for those people, and who might be forgiven for cynicism at the notion of villains becoming reformed, themselves testified to the extraordinary changes for the better. I leave your Lordships with a single haunting remark made to me by one of the inmates that I met. "How strange I often think it is," he said, "that I had to go to prison to find my freedom".
I ask my noble friend to continue to give every encouragement and help to this important initiative. I sincerely believe that it holds the key to so much that he is striving to achieve. Above all, I hope that he will have it in mind when he comes to reflect on any proposals he may have for the probation service, whose work is so closely intertwined with the problem of addiction in our prisons and throughout our community at large.
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