Select Committee on Home Affairs Minutes of Evidence

Examination of Witnesses: (Questions 40 - 59)



  40. But the fact is that in the last year or so they were doing what we had asked them to do.
  (Keith Hellawell) Yes, that is correct.

Mr Watson

  41. Mr Hayes, thank you for coming to speak to us just three months into your job; a daunting task. Could you sketch out to us why it was felt that we needed an organisation like the National Treatment Agency?
  (Paul Hayes) As I understand it, what the NTA exists to do is to provide more treatment, better treatment and more inclusive treatment. The history of treatment in this country, particularly over the last few years, has been one of success. We are able to demonstrate through the national treatment outcome research study, that treatment is effective and an awful lot of work has gone into improving the organisation of treatment. The time had come, particularly with the Government channelling very significant additional sums of money into the treatment arena, to assure ourselves and Parliament, the public, that best value was being gained from that additional investment. The NTA exists to improve the way in which treatment is managed in order to ensure that it is as effectively delivered as possible.

  42. What do you feel you are going to add to the drug treatment field which was not already there in the first place?
  (Paul Hayes) We are going to add clarity. We are going to build on the excellent practice which is already available. We are going to sharpen things. We are going to help local commissioners to commission more effectively, to make sure they understand the treatment needs of their population and the whole population, not just those people who historically access the services. They can then build treatment services which respond to everybody's needs, not just white, male opiate users, but users of stimulants, people from black and minority ethnic communities, young people, women. We shall also be helping them to manage those services more effectively, we shall be equipping them with consistent management information so that they can performance manage the services they commission and we shall be trying to make sure that the whole process of the commissioning of services through drug action teams and their local joint commissioning groups operates much more smartly. We shall also be helping to make the whole treatment field evidence driven. In the past, too often it has been characterised by belief systems rather than evidence. One of the key strands in our work will be to make sure that research underpins everything we do. We shall be initiating research ourselves, but more importantly we shall be working together with other people to make sure that the research efforts complement each other. The research effort within the Department of Health, within the Home Office, within various universities, the research initiated locally by DATs and by other people is sometimes not co-ordinated as well as it might be. We shall be working to ensure that it is co-ordinated better and that we also distill from that research what is best practice and then disseminate that to the field. If there is a better mousetrap out there, people will know that it exists and we shall be able to get information about that out to them in language which they can understand. We shall also be working to improve the consistency of service delivery across the country. We shall be working to develop standards of service delivery so that we can assure ourselves that the best practice identified by research is actually being implemented and then accrediting services, the people working for those services, the methods of intervention which are being used, to assure ourselves that the practice in Carlisle is very similar to practice in Gwynedd and that both of them actually match the practice which the research was undertaken into so that we can assure ourselves, the people who are commissioning the services and most importantly the people who are using them, that it is likely to have an impact. Another strand of work we shall be engaged in is workforce planning. Like many other areas of the public service the drug treatment field suffers from a difficulty in attracting suitably qualified staff and in retaining them. There will be three strands to that work essentially. We shall be working in partnership with other people, with people within the medical profession, allied professions such as criminal justice, social services, to make sure that staff working within each of those professions are sufficiently skilled to work with drug misusers. We shall be working within the existing drug treatment field to enhance its professionalisation so that the people working within the field are appropriately skilled and we can demonstrate that they are competent to undertake the tasks asked of them. We shall be working with their managers to improve their skills and we shall be working to try to attract more people into the field. The other strand of work we shall be engaged in is performance managing, as commissioners of local services, to ensure that the whole system in each area works as effectively as possible. Up to now the provision of treatment in this country has tended to be somewhat episodic. We need to build a treatment system so that when people enter it, their pathways are actually managed to achieve the best effect, so that they do not pass from agency to agency, falling through the cracks in between, for ever being assessed and not much being done. We shall be working with services locally to make sure that an integrated treatment system is developed, building on work initiated by the Department of Health. We shall also be working with people locally to ensure that the pooled treatment budget is spent to best effect, that other treatment monies are also spent effectively and that people have appropriate information available to them to performance manage that process locally and to give information to us and other key partners such as the Home Office about how the whole system is working.

  43. On the performance management, do you feel you have sufficient teeth to act where you find poor performance or is it really that you will just be exposing poor performance and you will not be able to make any changes?
  (Paul Hayes) We shall try to be both. There are levers to be pulled. We are not certain yet exactly how we shall use the pooled treatment budget and it may well be that we shall be able to manage that budget in such a way that we reward good performance and penalise bad performance although other areas of government have gone down that track and not all the experiences have been positive ones. We need to make sure that we do not actually wind up penalising communities and service users rather than poor commissioners or poor service deliverers. We are certainly prepared to look at ways in which we can do that. We do have access to other levers. We can call upon the various inspectorates to which the people providing services are accountable. We can call on the support of the local media. We can call on the support of Ministers if necessary. Several levers are available to us. Time will tell how appropriate they are and whether or not we need new ones. Certainly we shall then have discussions with the Home Office and the Department of Health if it turns out that our teeth are not sharp enough.

  44. How are you going to link it with the Health Development Agency and the National Institute for Clinical Excellence?
  (Paul Hayes) We need to establish links with a range of bodies and they are two. We also need to establish links with the royal colleges, with the agencies within the criminal justice system, etcetera. That has been part of the work we have been undertaking over the last three months. I have to say that has not been developed to the point of arriving at memorandums of understanding or any formalised process as yet, not least because we have been fully occupied dealing with matters we have inherited from the Department of Health and trying to recruit the key staff of the agency to enable us to be up and running as quickly as possible. We shall be working very closely with a whole range of bodies, including the two you mention.

  45. Do you know what the timescale on that is? Are you talking to them now or due to talk to them?
  (Paul Hayes) I have a meeting with NICE next week. We have staff seconded from the HDA so that those contacts are already there. There is a range of organisations with which we need to work very closely.

Mr Singh

  46. The findings of the British Crime Survey 2000 showed that the use of cocaine has grown in all age groups including 16 to 18-year-olds, the use of ecstasy has remained stable but is growing amongst men aged 25 to 29 and is higher in 2000 than in the previous survey. Before 2000 cocaine was more prevalent among the unemployed but in 2000 its use was as common amongst those with a job as without. Transform have said to this Committee—and I do not know who Transform are but I presume they are noteworthy if they are included in my brief—"UK drug policy has been an unmitigated disaster"; ACPO Sub-Committee on Drugs said, "the results are not coming through"; the Independent Drug Monitoring Unit said, "There is overwhelming evidence that current drug policies do not work". Is the government policy on drugs failing completely? Is it as bad as that?
  (Keith Hellawell) Not at all. We have to remind ourselves that we have a ten-year strategy which was published in 1998 and that lays out very clearly what needed to be done over the coming ten years if we were to make a difference. That difference will be made incrementally in all the four areas of work in schools, in the community, through treatment and in reducing the supply of drugs to this country. We have had a very short time, in order to get all the building blocks in place in the first two or three years—and in my published annual reports and plans you will see that there is a substantial amount of process measurement—in order to introduce these systems or provide the treatment or recruit the people or get the police stations involved in arrest referral schemes. If you look at that first phase of activity, it is very, very, very positive. Even in some of the areas where I did not anticipate that we would have any positive outcomes—outcomes rather than process management—certainly in schools and certainly in treatment intervention within the criminal justice system and in treatment intervention generally, we are beginning to see some benefits. We used the years 2005 and 2008 as milestones for measuring how beneficial all our activities are. If the question was—and it was not—whether all of these activities made a substantial impact on the drug taking of people within this country, the answer to that question would be no. But it was never anticipated that it would in the early years. The critics are using that. I was very pleased that the politicians did not expect that and I did not know whether they would and that is short-term results and using the fact to say "Look at what is happening, it is all getting worse". You will see in my early reports that I anticipated the rise in cocaine. I anticipated it back in 1996. If you look at some of the research there has been from Manchester University in relation to heroin, they are talking of the take-up rate of new heroin people, not the ones who are in the system that we are trying to catch, but new people, is actually slowing down or levelling off. If you want emotive things or headline things, thousands more children are now receiving drugs education than were before, thousands more people are now in treatment than were before. We have the most comprehensive treatment intervention programmes in the criminal justice system of anywhere in the world and that is beginning to pay dividends. Our re-focusing on class A drugs, particularly by Customs, by the intelligence agencies and by the National Crime Squad, is making a bigger impact than we had ever made. Way offshore, because my view was that it was too late when it got here; way offshore. There are several initiatives now in the system which are beginning to bear fruit.
  (Rosemary Jenkins) You particularly mentioned cocaine. The Committee has heard that the treatment in general is very successful in helping people get off drugs, but we are aware that the numbers of people coming into treatment to have their crack cocaine problems sorted out are much lower than those who are coming forward to have help with their opiate problems; only about six per cent coming in to treatment for cocaine. There is an underlying reason for that which is that the evidence on how to treat cocaine dependence is much weaker than the evidence on how to treat opiate dependence. There is a lot of good evidence around the use of methadone so it is clear there are good treatment procedures which can be offered to people which is not nearly as clear when one is looking at cocaine. For that reason we have decided in the absence of published evidence to bring together a group of people in the early new year who do treat people who have crack cocaine problems, to explore with them what they do, what their best practice is, where they have success and then we shall work with the National Treatment Agency and I am certain the National Treatment Agency will pick up the findings of that work in order to spread around the rest of the treatment sector approaches which we feel are likely to work better than perhaps we know at the moment.

  47. To reduce the prevalence of drug taking was one of the strategy targets..
  (Keith Hellawell) Yes.

  48. Given the British Crime Survey figures, and I understand what you have said, is there any point at all in government policy focusing on reducing the prevalence of drug taking? Would it be better to concentrate on reducing the harm that drugs do, treating people who have drug problems and hitting suppliers as hard as we can?
  (Keith Hellawell) The answer to that question is yes and that is the purpose of the strategy. I am sure you have read these documents, but the strategy says that we want to reduce the harm, damage and danger that drugs cause to individuals, their families and the communities and it is a preventive strategy. If you look at the change, people talk about the changes in Europe, this was the first strategy to have a balanced approach and was regarded by the international community as such away from either the very hard line or the very soft line. All of these come together and the main impetus over the last three years has been to train teachers, get more teachers in school to have clarity about what they are going to do, to have an inspection system through OFSTED which has clarity about what is happening in schools and huge amounts going into treatment, because we will reduce the prevalence of drug taking by providing treatment for someone. If they do not have to access the criminal justice system, we are going to reduce the demand. The balance of the strategy was and still is to reduce the demand as well as take the profit away from people who are benefiting from it. People sometimes overlook this. If I am addicted to heroin, I shall be involved in doing all sorts of things to feed my habit. I shall try to get you involved if you are a friend; I shall probably give you some. There is also my dealer on my back and he is going to give me a bad time if I do not pay my dues. I am going to be a sub-dealer for him. I have seen hundreds of these individuals; in my time in office I spent at least three days a week in prisons, in treatment centres, out in the community listening to people, so I am talking from three and a half years of experience speaking to thousands of people with problems. If we can provide treatment to an individual, and give him the support which we are now bringing in through housing support, through further education, through employment and all of those mechanisms which are in place and have been put in place in the last three years, then we can take him out of that. By taking him out of that we are taking away his need for those drugs and also his encouragement of other people to get involved in order that he can continue to support his habit. The strategy itself is very, very well balanced and balanced towards prevention and intervention.
  (Sue Killen) One point is worth making on the BCS which is that it is based on what was happening in 1999 and the strategy only started in 1998. I am not saying things would be markedly different if we had the figures for this year, but it is important when you are looking at a ten-year strategy that you do that. One of the things we find frustrating, which I am sure you will, is that if you are going to track something over ten years, inevitably you end up looking back because that is when you have the trend data. Having set up a ten-year strategy, we had to get research studies in place to start building up trend data and judging how we are performing against that is quite problematic because you are looking backwards. We are looking at things in two different ways: firstly, the evidence base on treatment is the strongest one we have. Paul mentioned earlier on the national treatment outcomes research study. This showed most definitely that if you get people into treatment, five years later you still have massively reduced drug use and offending. If we can expand the treatment part of the strategy and get people effectively into treatment, then that should start to impact on those trend numbers. If I am sitting there and I am doing an assessment for the Home Secretary, which is in effect what we are doing at the moment with the stocktaking review of how we are doing against the strategy, the linchpin in it is that pro-active spend. In SR2000 we got a really dramatic increase in the amount of money which can go into drug treatment, into the pro-active side of the drug strategy. We have the NTA, we have Paul in place now to make sure that money is spent effectively and our expectation would be that that then would begin to impact on the numbers. What I cannot do at the moment is give you the trend data to show that, so it is easy for people to criticise us. That strong evidence base on treatment is really important. We have other figures which we can show you that the introduction of drug testing in prisons has led to a 50 per cent reduction in the number testing positive and that is the result of the treatment regimes they have put into prisons. Keith is right. We have 90 per cent of schools now with effective education policies. We also have a lot of projects which we have trialed. We have shown they work in a small way and therefore we have rolled them out much more widely. I would put in that the arrest referral schemes, drug treatment and testing orders. It is early days and we have only just started to get the evaluations, but what we do know is that if we can get drug misusing offenders into appropriate treatment, the right treatment, the kind of treatment Paul wants to deliver, then we shall get reductions, not just in their drug use but in their offending behaviour and that will start to feed through into the statistics. We have also done projects with young people, particularly the vulnerable young people whom we need to target. Positive Futures was a really good scheme which we ran. We trialled it in 24 areas. We can prove that was successful and we now have the money to expand it to 50 areas. The overall message is that yes, we look at the trend data, but we also have to look at individual project evaluation and roll them out as soon as we know they are working. I would say to you exactly what I would say to the Home Secretary: we know there are areas where we need to do more and they are the ones we look at as part of SR2002. Top of my list I would put more emphasis on young people. It is a very difficult area. If you are dealing with people who have a multiplicity of problems, you are having to pull together at local level a multiplicity of players. It is not simple. We cannot come up with one single project which is going to solve this. It is all about the kind of thing Paul was talking about when he talked about the drug action teams. It is frontline workers at local level pulling together to provide the right support that these young people need. We need to do more of that. Rosemary has mentioned harm minimisation; a strand where we know we need to do more. The Home Secretary mentioned that. Lots of people criticise us. They place statistics as they want. I would say to you that if you want to come and see really effective drugs projects, which we are trying to spread much more widely, in your constituencies or wherever, we are very, very happy to arrange that.

  49. I can see you are a believer.
  (Rosemary Jenkins) I accept what is said about the trend data, but we have interesting figures on numbers in treatment or entering treatment. When these started flowing into the treatment services in 1998 what we could see very clearly in the two years of figures which we do have between then and the latest figures in September 2000, is a rise of 16 per cent in those two years of people coming into treatment, that is 16 per cent more people getting the advantage of the course of action which will help them.

  50. On drug testing in prisons, is it true to say that what has happened in prisons is that people serving time in prison have actually abandoned cannabis because of the policy and gone onto hard drugs which disappear from the bloodstream faster than cannabis, so are not picked up in the testing any more?
  (Sue Killen) No.
  (Keith Hellawell) No, that is not true. There has been an overall downturn in the number of those people who are testing positive in prison for all drugs. Cannabis was the most widely used drug. We know cannabis stays in people's blood longer but it was and still is I suspect the most used drug within prison. Whilst people have said that, our evidence from testing—and it is a universal system of testing in all our prisons—has indicated that there has been an overall downturn in those testing positive for drugs. May I put forward some reasons why? It is not just because more people are being tested and they are frightened of being found. It is because the prisons now have a regime to assess people and help people when they go into prison to deal with those problems. It is because many prisons have provided drug-free rooms and incentives to be drugs free. It is because we have given people support who want to remain drugs free to keep them away from those who would put them under pressure to get involved in drugs. If you look at any other prison system in the world, they are quite amazed that we have achieved that reduction in such a relatively short time. That is great credit to the prison officers and what is happening in prisons. The other interesting feature is that the prison governors used to have to do a ten per cent mandatory test. We gave them discretion within the new strategy to allow for them to focus their testing on areas where they felt concerned and also allow the prisoners themselves to ask to be tested to prove that they were drugs free. The self-initiated testing demand is going up like this because you are getting the balance changing from trying to beat the system to meeting the system in terms of "I'm drugs free and I'm proud of it and I want to prove I'm proud of it". The penalties within prison have been changed in line with that philosophy of prevention. The other thing which is often overlooked is the programme of rehabilitation. We are one of the very few countries in the world which has such a comprehensive support for prisoners when they leave. For eight weeks after they leave it is the responsibility of newly appointed prison staff to link within the community to provide them with housing, with education if necessary, with employment and continued treatment if that is necessary. This is an initiative in this country. It is one which is highly acclaimed throughout the world and those workers who are persevering under difficult conditions feel let down when they see newspaper headlines that it is all a failure, it is a waste and it is a total mess because they are making a difference.

  51. Going back to the ten-year strategy, has any interim evaluation been made? If so, can we expect the publication of a report at some stage?
  (Keith Hellawell) When we did the strategy I was anxious, because I only intended to stay three years, that at the end of those three years we evaluated openly both my post and the strategy. Because of the election, the strategy is being evaluated now.
  (Sue Killen) We are doing what we are calling a stock-take review and it has several purposes in effect. We are looking at the targets because we said we would. We said we would take a really hard look at progress against the targets, whether we had the balance right at this particular point, so we would go back to Ministers anyway. In addition, SR2002 now gets under way so it is important that we do a thorough review of the strategy so we can look at funding lines for the next spending round. That process is going on at the moment and will more or less run to the SR2002 timetable. The normal expectation is that at the end of that the Government will publish something which outlines the decisions they have reached.

  52. It has always puzzled me to find that drugs strategy is with the Home Office. Is that because we see drugs as a problem of crime rather than health? Now that Keith Hellawell, our czar, has gone, what is the co-ordinated mechanism between the courts and health?
  (Sue Killen) It might be worth giving you a bit of history here. I find it surprising that I am now in the Home Office. I was on secondment to the Cabinet Office to co-ordinate the whole strategy and the system we had before involved far more departments. My old team in the Cabinet Office has now moved to the Home Office. That actually gives much better clarity. We were in a situation before where responsibility for drug action teams who deliver the strategy at local level was in my unit, whereas the drug prevention advisory service full of experts who provide that support in the field to the DATs was in the Home Office. The whole lot has been brought together and the Home Secretary has responsibility for driving forward delivery of the whole strategy. When you took evidence from him last week, we were seeing that he is extremely keen on issues such as harm minimisation and the whole range of the drug strategy. In a sense it does not matter where we are so long as we have the right responsibilities to drive the whole thing forward.

  53. Can we be reassured that you are in the right place?
  (Sue Killen) Absolutely. I would emphasise that the five of us here are people who deal with each other all the time anyway. I, for example, am on the board of the National Treatment Agency with Paul. Rosemary and I trooped around the country doing a huge consultation exercise last year on setting up the NTA. What we have are cross-departmental teams and we do this between us because it is the only way we can.
  (Rosemary Jenkins) The whole strategy has moved to a criminal justice agenda and away from health. The thing we have to remember clearly is that many of the activities which are rightfully happening within the Home Office, drug treatment and testing orders, referral schemes, are there to get people into treatment but the end result is actually a public health measure. It does not really matter which department is running it. We have spent the last three and a half to four years working closely together over measures like that and shall continue to do so.


  54. May I just ask about targets? Whose idea were these targets? Mr Hellawell, are you owning up?
  (Keith Hellawell) Yes. I am quite proud of the idea. Having been a chief constable for almost ten years, I have had responsibility for a substantial area where the performance indicators which were set for us were indicators of process and they were indicators which meant we could achieve and improve but it would not make any difference in the community. As a chief constable I spent one day a week out in the community and I was not duped by figures which showed we were doing well, when in reality it was bad out in the street. I was determined that when I came to do this job, we would see some positive outcomes from this. It is interesting—maybe I should have done it, but I am not a politician—that if I had used the old idea of process measures, I could be saying to you now that on all these measures we had achieved our targets. I would have thought that you are certainly sophisticated enough to query whether that had actually made any difference. That is why for me those targets were extremely important.

  55. Are they a bit ambitious?
  (Keith Hellawell) Yes, I suppose they are. The idea of the old targets on availability, for example, was more arrests by the police service, and that was quantity not quality, more seizure of drugs by Her Majesty's Customs and Excise, which was quantity not quality. I stood up for three or four years as a chief constable with the Head of Customs and said, tongue in cheek quite frankly, that we were doing well because we had seized more drugs and arrested more people. Towards the end of that I felt less comfortable with that because I saw in the communities that the position was getting worse. I did not have the power to do it, I had to influence Ministers, but I was determined that we ought to have some positive outcomes. The performance indicator in schools was the percentage of schools which had drugs policies in place. I asked both the schools inspectorate and educationalists why we can achieve 100 per cent coverage of schools and not make any difference to the drug taking habits and experimentation of children. I was keen in all of these areas that what we would achieve were outcomes. Now, your point about where they came from. There was substantial resistance both from the civil service, the agencies and Ministers to introducing targets, for understandable reasons. Much more comfort with process measures. It is fair to say, certainly in the ministerial committee I worked to then, we put forward a convincing argument that if we wanted the agencies to engage then we would have to set some targets for them. They would have to see that the results of their activities were making a real difference in the community. The only precedents we had were the Americans and the Australians who had actually done a great deal of work on this. Whilst we did not adopt their measures in full, and there was substantial consultation within agencies and a reluctance to engage with me, those came out as a compromise at the end of the day where some research had been. I saw them certainly as aspirational and the three-year review was a good time to measure ourselves and see how much progress we had made and see how realistic they are as time moves forward.

  56. On what were the targets you set based?
  (Keith Hellawell) They were based on what we felt—and it was not an individual decision—we were likely to achieve. To give you an example, on the ability ones I pulled together all the people, and they are now in a formal committee, and asked whether, if we continued in the way we were, we would really make a difference to the availability of drugs on our streets. I am delighted to say that they said the answer was no. We can put some superficiality on it: maybe we can get ten per cent more, if we have more resources maybe 15 per cent more, but we are not going to make a real difference. We did this in all of these areas to find out how we could make a real difference. That is why we have the advice and guidance in education, why we set the targets to increase the treatment and have some consistency through the creation of the National Treatment Agency and also the policy on foreign policy, moving beyond the shores to do that. Where did the actual figures come from? There was no statistical analysis. What we did back in 1999 when those were government targets—often they are put as my targets; people have distanced themselves from them—was decide on the basis of research we had, and you have already heard some of that is pretty frail, and we would supplement that by further research in bringing forward base data. I anticipated, indeed promised, in my annual plan for 1999-2000 that base data would be delivered by the year 2000. Some of those have not yet been delivered because of the complexity, not because people are not doing their job.

  57. Is not the danger with ambitious targets—and as you know this is a government which likes targets—that you set yourself up for failure?
  (Keith Hellawell) That was one of the issues which politicians were clearly concerned about. Across those targets which we have, and the review is going on at the moment, there is a realism about achieving not all of them but some of them; the treatment one, for example. The Government have now backed all of the strategy with money. I chaired two cross-cutting financial reviews and the money was given to support the strategy. It was not a matter of providing money for treatment it was actually recruiting people to do it because they were not there. The speed at which that will be achieved is the speed at which we have people coming on stream who are trained to deliver the treatment. The money is there to support that. We will see a flat period and then we shall start to see some climb.

  58. Are you confident that we shall achieve all or most of them?
  (Keith Hellawell) No, I am not confident at all about achieving all or most of them. What I do believe is that the targets were necessary. With the knowledge we had at that time, rather than to pick them from the air, to base them on the only two other countries in the world who had set targets and these were the base targets they had set, was sensible and reasonable at the time. We are now looking to see how realistic they are in the light of delays in recruiting people.

  59. Might we find the downward revision coming up in the near future?
  (Keith Hellawell) No, that is not part of my work quite frankly.
  (Sue Killen) I can only repeat what I said before and the Home Secretary said in his memorandum to you, which is that we are having a really good review of the targets and the strategy at the moment and that is ongoing.

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