Jon Ashworth speech at the National Substance Misuse Conference
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Speaking at the National Substance Misuse Conference, Labour’s Shadow Health Secretary Jon Ashworth, said:
Good afternoon, may I start by thanking you for the invitation to offer a few remarks to you today and to let you know when I received the invitation it was one I very quickly accepted.
I address you today as a Labour MP and someone who aspires to be the Health and Social Care Secretary in the next Labour government.
And the reason I so wanted to join you today is because I want to be a Health Secretary who prioritises substance misuse services in society, a Health Secretary who finally gives addiction services the investment and political support needed, and a Health Secretary who sees my role as not just ensuring our NHS has the resources and staff to prevent ill health and save lives but also crucially sees my role as protecting the health and wellbeing of all in society too, for as the World Health Organisation tells us health is not only an absence of disease but a state of complete physical, mental and social wellbeing.
For me that must mean a bigger emphasis on public health, substantial and sustained investment in public health services underpinned by a strategy to address the wider social determinants of health inequalities in society too.
So this afternoon I want to offer a few brief remarks and invite you to work with us as we develop our plans for government.
I believe we are facing an addiction and substance misuse crisis. While over the last decade I accept the prevalence of illegal drugs has fallen, deaths related to drug misuse are at their highest levels since records began.
The UK remains the biggest market for heroin in Europe consuming an estimated 14 tonnes of the drug every year – 5 tonnes more than Germany the second highest consumer. Estimates suggest 1 million people are dependent on illegal drugs in England with 300,000 dependent on heroin and/or crack cocaine.
And what of our future generations? Use of cocaine by 15-34 year olds and the school age population is in the highest band compared to the rest of Europe.
The numbers of our fellow citizens estimated to be dependent on alcohol is 1.6 million and those in need of specialist treatment has now topped 600,000, and yet the number of adults receiving alcohol treatment is at its lowest level for nearly a decade. Over the last five years the alcohol dependent population rose by over 15,000, whilst the number of adults in alcohol treatment fell by over 11,000.
Deaths relating to alcohol consumption are 5 per cent higher than ten years ago. On a narrow measure, there were around 337,000 hospital admissions related to alcohol consumption, that’s 17 per cent higher than ten years ago.
Every life lost to drug and alcohol misuse is a tragedy, every life consumed by addiction is a waste and we know it devastates families as well.
1 in 10 adults lived at some point during their childhood with someone who misused alcohol and 1 in 25 with someone misusing drugs. Today it is estimated that over 200,000 children in England live with at least one parent or carer who is alcohol dependent.
We know the Adverse Childhood Experience of growing up with a parent with substance misuse issues can impact on the future life chances of that child.
It can mean the tragedy of a robbed childhood growing up in a home with a risk of physical or sexual violence.
It should shame us as a society that parental alcohol misuse is involved in up to 37 per cent of child abuse cases, and that alcohol and drug abuse leads to children taken into care with around 61 per cent of care applications in England involving their misuse.
Or it can mean the emotional neglect of a child detrimentally impacting their mental wellbeing.
It can often mean parents abandoning their responsibilities as parents forcing children to ‘fend for themselves’ as they have no option but to take on as best they can ‘adult’ responsibilities.
It means children suffering from direct physiological effects and Foetal Alcohol Spectrum Disorders as a result of pre-natal exposure to alcohol.
And it can often lead to children themselves getting involved in drink or drugs, suffering mental health problems, experiencing stigma and isolation.
In the words of the World Health Organisation it all adds up to a ‘cycle of violence’ as substance misuse impacts on children who have their lives coloured by these experiences and who in turn are at increased risk of exposing their own children to adverse experiences such as substance misuse.
Of course we know that not all children who experience the adversity of growing up with a parent who misuses substances go on to misuse substances themselves.
I know that for myself. Because my late father was an alcoholic.
You may have seen I chose to speak out very personally in Parliament about my own experiences growing up with an alcoholic father and what that meant for me.
I don’t need to repeat the stories here today. I can tell you that when I say this issue is a personal commitment of mine, I say it with heartfelt sincerity.
It’s why I was pleased – I know it is rare to praise a Tory politician – but I was pleased when Jeremy Hunt as Health Secretary earlier this year announced £6 million to fund a children of alcoholics strategy following the campaigning work of politicians like Caroline Flint, Liam Byrne and myself. I worked very closely with NACOA on this important issue.
But we need to go further so it’s a pledge of mine that the next Labour government will implement a fully resourced national strategy to support children and families affected by alcohol and drug misuse backed up by clear national minimum standards.
Over these last few months I’ve spent time on the front line with substance misuse professionals. I’ve seen for myself your dedication, care, professionalism and skill.
I’ve enjoyed the privilege of observing in a residential detox facility the extraordinary work of GPs and nurses supporting those who have been referred for specialist treatment and help; I’ve seen staff in treatment centres going the extra mile again and again for service users with some of the most difficult complex needs. I’ve spent time with consultant psychiatrists understanding the changing pressures on the frontline; I’ve sat in and participated in group therapy sessions with the support team.
For example, just last week I visited the Passmores House residential treatment centre in Harlow, run by WDP. Shown around by their Medical Director Arun, I met their fantastic team of staff who give so much to help their patients and service users through detox and recovery – not just clinicians but social recovery workers, management, kitchen and facilities staff too. Helping people not just overcome their illness but building up patients’ recovery capital to help them rebuild their lives too.
Their dedication as a team was plain to see. I also had the chance to speak to some people undergoing treatment. Hearing from service users who spoke plainly about what they had lost brought home to me the importance of the work that you do. I heard from one person who said they had lost a family member to drugs, but had continued to use even at the funeral to deal with the pain. I heard from people who had suffered major injuries because of their addiction to alcohol. From people who had lost their families and their livelihoods.
But I heard too about how funding for support has been cut back, about the growing waits to access services, about the pressures it puts on peoples’ lives and families when they often have to wait years on end to access the support they need.
I have learnt how it’s becoming harder and harder for you to deliver the levels of care, support and rehabilitation service you want to offer. And how financial squeezes mean providers giving up on tendering for contracts. I’ve heard how retendering for contracts every three years is wasteful of resources and destabilising when staff are TUPED over again and again. I’ve heard how financial strain has meant cutting back on outreach work, that in community treatment services caseloads are getting bigger and bigger, and commissioning decisions are forcing reductions in the days the most vulnerable can expect in detox and rehab beds.
Since 2013 the sector has seen cuts of £162 million from treatment budgets, spending on detox and rehabilitation services has had to fall by £4 million over the last four years. In many of the local areas that have suffered big spending cuts to services have also seen increases in drug related deaths.
What’s more because of the way in which the internal market operates in the NHS, many NHS hospital based specialist inpatient addiction units have closed, unable to compete with independent providers. Ten years ago London had eight NHS inpatient drug and alcohol treatment units providing specialist care; all are now closed. But as you know inpatient addiction services treat the most vulnerable with complex physical and mental health co morbidities. The loss of this tier of NHS provision undermines clinical safety, impacts on training the next generation of clinicians and undermines clinical research.
So overall a bleak picture and I’m afraid there are more cuts to come. Our research reveals that £34 million of cuts are planned to substance misuse services, as part of the government’s wider cuts to public health worth £800m by 2020/21. On current plans, 97 local authorities are planning on cutting treatment services for drug misuse in adults, whilst 87 local authorities are set to cut adult treatment services for alcohol misuse. Shockingly 80 councils have budgeted to cut specialist drug and alcohol misuse services for children and young people totalling over £7 million.
But when deaths from drug misuse are at their highest level on record, when –as our new research shows 600,000 people are dependent on alcohol needing treatment, when 200,000 young people are growing up with a parent who has an alcohol misuse problem, or up to 350,000 with a drug misuse problem then we have a responsibility to act.
Not just for the sake of those individuals whose life has been devastated by drug and alcohol misuse, not just for the children affected but for society as a whole as well.
Yet austerity has meant cutting treatment services for some of the most vulnerable in our society. It is devastating, misguided and completely counterproductive. I honestly believe it’s pushing addiction services to breaking point.
The Advisory Council on the Misuse of Drugs has warned these cuts are “short sighted and a catalyst for disaster.”
These cuts are pushing addiction services to breaking point. It’s especially shameful, with so many new drugs on our streets that young people are using such as spice, that specialist drug and alcohol services for young people are being slashed as well.
It makes no economic sense either. According to Public Health England, drug treatment reflects a return on investment of £4 for every £1 invested, whilst alcohol treatment reflects a return on investment of £3 for every £1 invested.
The combined benefits of drug and alcohol treatment are worth £2.4 billion. The savings are in a number of areas, such as crime, Quality Adjusted Life Year improvements and health and social care.
I agree therefore with Simon Stevens who told the Health Select Committee:
“An area where you get very quick payback, or indeed a worsening of the situation if those services are not there, for example, is drug and alcohol services and sexual health services. If those services diminish, that shows up as extra demand in more expensive parts of the National Health Service within 12 months, not within 10 years.”
So should I become the next Labour Health Secretary my personal commitment, as Health Secretary, would be that drug and alcohol addiction services will no longer be a neglected, under resourced service. The next Labour government will expand substance misuse health services to ensure the most vulnerable in our society are given the support, help, rehabilitation and care they need and deserve.
A major expansion of substance misuse services is our ambition. As we get closer to a general election we will outline our spending plans for health services, but we are committed to maintaining the public health ring fence and if we were in government today we would be spending an extra £7.7 billion on health services in our first year.
Government ministers tell us they are serious about prevention but as Duncan Selbie from Public Health England reminded us last week, the Five Year Forward View’s promises on prevention hadn’t been implemented. I agree.
And my challenge today to the current Health Secretary is this, if you are as serious about prevention as you claim, a key test of the upcoming NHS Plan is to reverse the cuts to substance misuse services and give some of the most vulnerable and their families the full care they deserve.
As you know the 2012 Health and Social Care Act – something my party is committed to reversing – shifted public health provision to local authorities while at the same time imposing swingeing cuts on local authority budgets. I want to engage in a discussion with you and the wider sector about whether or not services should be brought more directly into the NHS family again. I have my own personal views but I want to listen to what practitioners on the ground think. But whatever the outcomes of those discussions, I certainly think for now as part of the upcoming 10 year plan Ministers must insist that drug and alcohol misuse services are mandated as part of the public health responsibilities of local authorities and backed up by the resources necessary.
And we must tackle the constant re-procurement of addiction services’ contracts between service providers and local authorities to ensure the continuity of care and stability in treatment systems which vulnerable patients and the hardworking staff around them require.
We are also facing a crisis in the addiction workforce, which the Advisory Council on the Misuse of Drugs have described as “one of the most significant barriers to recovery outcomes.”
The addiction workforce has witnessed substantial cuts, meaning fewer specialist addictions psychiatrists, clinical psychologists, and nurses. The number of training posts in addiction psychiatry has decreased by 60 per cent since 2006, whilst a 2017 Royal College of Psychiatrists census found that the NHS had 20 per cent fewer consultant addiction psychiatrist posts than four years ago.
Pressures on frontline staff are evident in rising caseloads and an increase in replacing one-to-one client contact with group work.
In the words of one Chief Executive quoted in the latest State of the Sector report, “We are taking on more than we can do, but there is always a need for more.”
All of this is contributing to a failure to support the most vulnerable and an inability to provide NICE-recommended care for patients with complex dual diagnosis presentations, especially around early intervention. That’s why Labour is committed to a major new Substance Misuse Strategy working with professionals, experts and service users, which will include a detailed review into the drug and alcohol treatment workforce.
Therefore, workforce gaps across the whole of the NHS and public health landscape must be a priority for the government in the coming months and the government must bring forward a workforce plan that supports this sector. We, for example, find the Royal College of Psychiatrists call for the number of addictions psychiatry post in England to return to 60 very persuasive and will be looking to see if the NHS delivers a sustainable solution along these lines.
But we must also improve integration with mental health services too. Dual diagnosis between mental health and substance misuse should be the expectation. Not the exception.
Because we know mental health problems, such as anxiety, depression or personality disorder, are experienced by the majority of drug and alcohol users in community substance misuse treatment, whilst nearly half of community mental health patients have reported substance misuse in the previous year.
And yet just 1 in 4 people with a diagnosed mental health problem in substance treatment are also receiving mental health treatment. This simply isn’t good enough.
More than 95 per cent of respondents to a recent joint Centre for Mental Health and Institute of Alcohol Studies survey wanted more collaborative working between alcohol and mental health services, for mental health staff to have more awareness of alcohol issues, and for alcohol service staff to have more awareness of mental health issues.
So as part of Labour’s major expansion of addiction services, we will ensure better links between addiction services and mental health services. We also agree with NHS Resolution’s recent recommendation that a referral to specialist substance misuse services should be considered for all individuals presenting to either mental health or acute services with an active diagnosis of substance misuse.
This is especially important following the organisation’s recent finding that those with an active diagnosis of substance misuse were referred to specialist services less than 10 per cent of the time.
And – it is National Suicide Awareness Week – Labour will also ensure local suicide prevention plans include action to address the links between alcohol misuse, deliberate self-harm and deaths by suicide. Because suicide remains the leading cause of deaths for adults between the ages of 20 and 24 in the UK. In England in 2016 there were 4,575 suicides registered- a year-on-year fall, yes, but still 4,575 suicides too many.
Finally, as an emergency antidote for overdoses caused by heroin and other opiates, we know Naloxone saves lives. I recently learnt about the work by Newcastle City Council in ensuring greater access to naloxone since the recent legislation changed widened its availability. It’s important best practice is spread so I can tell you it would be our commitment to work with you to ensure Naloxone is consistently available across the country ending the current postcode lottery of provision, in which, according to LGA research, 10 per cent of local authorities still do not make available take home naloxone.
So thank you again for inviting me here this afternoon. The commitment of my Party is to support you, to provide the investment needed and work with you so our substance misuse services can be the envy of the world and offer the genuine care and rehabilitation so many vulnerable people in society deserve.