Examination of Witnesses: (Questions 60
TUESDAY 30 OCTOBER 2001
60. Remind me when that is likely to reach a
conclusion in relation to targets?
(Sue Killen) It will run alongside the SR2002 work.
It will run through until early next year, conclusions around
Easter, definitely results before the summer, that kind of thing.
61. So we might see some revised targets next
(Sue Killen) That very much depends on the outcome
of the work we are doing.
62. So the answer is yes, we might. That is
all I am asking.
(Sue Killen) It is a possibility, yes.
63. Is there any research on whether alcohol
is a gateway, entry for very young people to drugs? I think most
of us would agree that there is a terrific amount of binge drinking
nowadays amongst the very young; any street in the country on
a Friday and Saturday night, many, many youngsters, 16 or 17,
nice young people but they are in a binge drinking culture which
did not exist in the past. Does that in any way in your research
connect them with a drug scene?
(Keith Hellawell) The linkage is more through tobacco.
The first study I saw was one in London completed probably six
or seven years ago, which was 2,000 children in London and those
who smoked regularly were 22 times more likely to be involved
with drugs, the drug being cannabis, than those who did not smoke.
More recent surveys have indicated a higher linkage than that
and that is why the education programme we are introducing in
schools starts with the medicines which children will find in
their home, moves on to solvents, because about 80 of our children
die each year through solvents, and then moves on to alcohol and
tobacco. May I give a lie to some of the media responses that
it is all based on legal and illegal? Our educational programmes,
because of the prominence of smoking and the relationship between
smoking and smoking cannabis, have smoking high on the agenda
within our education on what you would call drugs. I would rather
call it substance educational programmes. The linkage between
alcohol and drugs is less defined; it is more cigarettes.
(Sue Killen) One of the key things we introduced following
the spending review 2000 was young people's substance misuse plans
which are integrated planning for vulnerable young people at local
level. They look at substance use, not just drugs. If you are
looking at vulnerable young people, it is very difficult to say
whether you are protecting them from going on to alcohol or whatever.
It is actually targeting those who are most vulnerable.
64. Are some of the targets not rather pie-in-the-sky?
The evidence we have been given shows that cocaine use went up
about 400 per cent in the six years to the year 2000. It went
from one in a hundred to five in a hundred for the under-25 group.
Your target is to cut it by 50 per cent by 2008. With such a recent
increase is that not just hopelessly optimistic?
(Sue Killen) Are you talking about drug use in general
or amongst young people?
65. I am talking about your key performance
target which is to reduce the proportion of people under 25 in
terms of cocaine; a 50 per cent reduction by 2008. Is that pie-in-the-sky?
(Sue Killen) The general position on young people
is that use is falling not rising, particularly in the 16 to 19-year-old
group. We have evidence of a reduction there and that reduction
is based on reductions in LSD and amphetamines.
66. I am particularly asking about cocaine.
(Sue Killen) Cocaine is the thing which is beginning
to buck the trend. It is an increase for16 to 19-year-olds from
around one per cent to around four per cent. That is the reason
why we know that we want to focus on that very quickly and try
to do something about it. The point I would make again is that
this is based on data in 1999, so it is ahead of a lot of the
things we have introduced on young people. Young people is one
of our priority areas for the future; it really is.
67. Just listening to you this morning I get
the impression that you are thinking, in terms of your four aims
at the moment, that you are moving towards giving treatment as
a whole a greater weight in the strategy while at the moment everything
is balanced. Would that be right? Is that a right impression to
take away from what you have all said, that treatment is going
to get a bigger emphasis?
(Sue Killen) Treatment already has a bigger emphasis.
If you look at the monies which came out of SR2000, there was
a big shift to expenditure on what we call pro-active spend. It
is actually trying to deal with the problem rather than dealing
with the consequences. There is a big increase in treatment, big
increase in young people as well, but on treatment we have a much
stronger evidence base on what really works. On prevention activities
we have some evidence and we are making maximum use of it. This
is an area which is much more difficult and we are in no different
a position from anywhere else in the world. There is nowhere at
all in the western world which has got this one completely sorted.
(Keith Hellawell) In terms of the philosophy, when
I first looked at the amount of money we spent on anti-drug activities
in this country in 1998, we spent 63 per cent of all our money
on the criminal justice system. I said in my first report to the
Treasury that two thirds of our money spent on dealing with the
consequences was a bad policy. Therefore the philosophy was that
we changed that emphasis, firstly by new money coming into education
and treatment, secondly by the enforcement agencies using some
of their money and this is why prisons are involved in treatment,
the police service is involved in treatment.
68. What is the figure now? If it was 63 per
cent, what is the equivalent figure now?
(Keith Hellawell) I am not involved in SR2002, so
I do not know. I know there was a shift in the last spending review.
Mr Cameron: It would be very useful to have
that to see what has changed.
69. Why are alcohol and tobacco not integrated
into the drugs strategy?
(Rosemary Jenkins) Tobacco has an approach of its
own. We have to recognise that the two substances are somewhat
different in that they have legal status rather than illegal status,
which means that the way in which you approach them has to be
very different. I would have to come back, if you wish, with some
details on tobacco because that is not my part of the Department
but I am happy to give you some written evidence on that. The
Department is working on various approaches to tobacco in a very
positive way. On alcohol, the NHS plan is committed to producing
an alcohol strategy in 2004 and at the moment we are looking at
developing a consultation document which is likely to come out
next year some time which will explore some of the areas which
could be covered by that strategy. It is much more complicated
than drugs because of the general view that it is legal and most
people manage their alcohol in a perfectly legitimate and reasonable
way. So any strategy has to take account of that societal attitude.
When the National Treatment Agency was set up Ministers did ask
us to have a look to see whether in fact there was an argument
for the NTA to take over the role of treatment of people who have
an alcohol dependence problem. A working group has been working
through the summer on that and has just made its recommendations
to Ministers. We are expecting very shortly a decision on whether
the NTA will take over that role.
70. I should like to ask about drugs education
work as a method of preventing drug use. What forms does it take?
Does it involve an understanding of personal responsibility? How
does it compete with the ever-increasing availability and affordability
(Sue Killen) Drugs education in schools is combined
in the PSHE strand, that is personal, social and health education.
It is being massively expanded so that over 90 per cent of secondary
schools have drugs education. What we are increasingly doing via
things like the Healthy Schools standard and work of the local
DATs is trying to make sure that the education there is is the
best, that it is based on sharing best practice and it is the
approach which is most effective in terms of stopping young people
turning to substance abuse.
71. Is there evidence that it is working or
does it need a radical rethink? Are young people in the main disregarding
this wealth of information which is put in front of them?
(Sue Killen) The expansion which has happened has
been very recent. What we have is extra funding, which has gone
into this. There is an evidence base that this type of education
works, so having expanded it, one would expect it to be effective,
but it is early days because this expansion has happened over
the last couple of years.
72. When can we expect an assessment of the
success of the current youth drugs policy?
(Sue Killen) I would say that in the stock-take review
we are doing at the moment, the effectiveness of what we are doing
on young people will be one of the key things we really do want
to look at. The other thing I would say is that on young people
that is where the evidence base is weaker and it is weaker here
in the UK but it is weaker across the rest of the world as well.
We share evidence between ourselves but finding out what will
be most effective is quite difficult. One of the things I had
forgotten about is that there is evidence from the US that if
you have a multi-faceted approach at once then that can be really
effective. That is not just having schools education but backing
that up with community work, local media and a whole range of
activities which are all focused on trying to tackle the issue
at once. What we are going to fund, which ties in with what I
said before that the really effective thing to do is trial projects
and if they are effective roll them out, is where we are using
something we are calling the blueprint programme. Over the next
year to 18 months what we are going to trial in 50 sites is that
kind of multi-faceted approach to see whether that is more effective,
to be based around 50 schools, 25 where we do the multi-faceted
approach, 25 where it is the normal state education. We shall
be able to see how effective that is.
(Rosemary Jenkins) We look forward to the results.
(Sue Killen) I had blueprint written down in my briefing
pack and I had completely forgotten about it.
73. Could we move briefly on to treatment. May
I preface my comments by saying that the success of any treatment
regime must surely depend upon a reducing number of people presenting
themselves for this treatment, hence the links with deterrence.
What is the Government doing to reduce morbidity and mortality
rates among drug users through harm minimisation?
(Sue Killen) There is quite a harm minimisation to
the strategy. We have quite a number of things already under way,
but the key thing is that Department of Health will shortly be
publishing the action plan on drug-related deaths.
(Rosemary Jenkins) Putting treatment aside, which
is the major harm minimisation programme we havegetting
to treatment harms do reducewe have a long and very distinguished
history of providing programmes to limit the health problems of
those who continue to misuse drugs. Key to that are our programmes
of needle exchange. We have around 2,000 needle exchange outlets
around the country covering at the last count 99 per cent of all
health authorities. We have not found the one which does not have
them yet. We gave out 27 million needles when we conducted that
survey, so there is a very, very widespread amount of activity
to help reduce the harm that injecting and sharing of equipment
provides. Very recently, in the last three years, we have put
money to health authorities to increase and kick-start programmes
for hepatitis B vaccination of drug misusers to reduce that and
this year we have produced documentation for people working in
drug services to help them to respond and help drug users to understand
the techniques to avoid getting hepatitis C. Our guidance on hepatitis
C has been widely circulated. Backing that up, this year we believe
that one of the things we have to do is increase awareness and
skills of drug workers and all of those working with drug misusers
so we have been starting a series of skills-based seminars around
the country which the University of Kent and DrugScope are principally
running for us to increase the skills base of professionals to
help drugs misusers to understand what they can do to reduce the
harm that is suffered. Finally this year we have also piloted
some very interesting work which we are hoping to roll out. We
are running eight pilots looking at giving first aid instruction
to drug misusers so that should they be present at an overdose
they would know how to respond with very simple first aid measures.
The evaluation of those pilot studies was extraordinarily positive,
including one which reported that it felt a potential drug death
had been avoided as a result of the programme. We are beginning
to roll out quite a lot of stuff.
(Keith Hellawell) The point about a successful treatment
policy will be shown in the reducing number of people going into
treatment. That is true if we are currently treating 100 per cent
of those who need it. If you measure it on that you will see that
the policy is a failure. When I first came to this job we only
treated between one fifth and one quarter of people with drugs
problems. So the performance indicator was to increase the number
of people in treatment. Once we achieve 100 per cent, which is
the target, then hopefully we shall start to draw.
74. That is the difference between the proportion
of existing drug users you are treating and a reducing proportion
of new drug users.
(Rosemary Jenkins) Yes.
75. One final question about prices and purity
of street drugs. Is there any data on this? Is there any noticeable
trend? How does that link into availability?
(Keith Hellawell) This was one of the measures I used
in terms of trying to change the systems we were operating. Over
the years the prices of drugs in real terms have not gone up,
they have maintained the same level or gone down. The purity has
not reduced. Although there is evidence that some of the work
we have been doing internationally with precursor chemicals, in
particular potassium permanganate and we are now dealing with
acetic anhydride, there has been some reduction in purity of cocaine
in America. It is frail information, but it is linked to the international
controls we have tried to put on potassium permanganate. On the
streets of this country the prices are reduced, the purity is
76. Just to keep things in perspective, the
figures seem to show that drugs misuse costs the NHS annually
over £234 million. I understand from your own paper that
the figures for the annual cost of smoking to the NHS is between
£1.4 and £1.7 billion. There is quite a contrast between
drug misuse and smoking and the cost involved to the NHS.
(Rosemary Jenkins) Those figures came from a very
small preliminary study to give us some idea of whether it was
worth looking in some depth at the actual cost of drugs to the
NHS. The figures for that reason are very under calculated and
much of that work has now been picked up with a much larger study
which is being led by the Home Office, which includes both costs
to the NHS and other economic costs as well.
(Sue Killen) We have a study underway at York University
trying to estimate the total costs of drug abuse. This is a vital
piece of information which we need, both to underpin the work
we are doing in SR2002, but I also think that it is information
which the Committee might find helpful. I have mentioned before
that when that report is available, or if it is going to take
a while for it to be available, we can possibly give you headline
information from it as soon as it does become available.
77. As far as tobacco is concerned, I am quoting
from your own paper where you say the figure is between £1.4
and £1.7 billion and you say that comes from the University
of York Centre for Health Economics, so there is no dispute that
this is the figure, which is the annual cost to the NHS of smoking.
(Sue Killen) Rosemary has dealt with that. There are
other costs involved too. For example, we do know that the cost
to the criminal justice system of drugs is some £1.2 billion.
78. Do the figures just quoted include the cost
of drug related crime? You do not hear of people committing crimes
to feed their tobacco habits.
(Sue Killen) The £1.2 billion I quoted is the
cost of treating drug offences.
79. It is just the medical side.
(Sue Killen) No, no, it is the criminal justice cost.