Health and Social Care Bill

My Lords, we return to an issue of enormous significance for the individuals and families affected. I refer of course to those suffering from addiction, or withdrawal from addiction, to certain prescribed drugs. I am grateful to the noble Earl, Lord Sandwich, for his amendment, which would put in primary legislation a requirement for clinical commissioning groups to provide a specific service and, in so doing, to co-operate with and take account of the good practice of specialised agencies. I think that the desire for good practice and for improving practice is common ground between us. The noble Earl will know that local areas are currently responsible for the design and provision of treatment and support services. We think that that is right. Having said that, it is clear that we need to do all we can to prevent dependence occurring in the first place. I am fully with him on that. For those who do develop dependence, it is important that they have access to the services they need to help them to recover, rebuild their lives and contribute productively to society. By placing the funding and responsibility for commissioning services to support people to recover from dependence with the local authorities, the Bill will provide local areas with opportunities to improve integration of commissioning and provide more effective joined-up services to meet local needs. I heard what the noble Earl said about generic drug and alcohol services and his view that they are not appropriate for people who are addicted to benzodiazepines. I beg to disagree with him on that. Drug and alcohol action teams are the people best placed to help people addicted to drugs of whatever kind. They commission to provide help for a wide range of drug users, including people dependent on medicines like tranquilisers, sleeping pills and painkillers. It is not a one-size-fits-all approach. In many cases, services for people dependent on such drugs are provided at different sites or times than those for people dependent on illicit drugs. The noble Earl has put forward an extremely powerful case and I do not wish to detract from that in the slightest. He is right to highlight the particular needs of this patient group. Nevertheless, we remain of the opinion that it is not appropriate to require in the Bill that CCGs commission particular services for all persons. CCGs are already under a duty to commission services to meet the reasonable needs of all the people for whom they are responsible. As noble Lords will be aware, they have a duty to ensure that they obtain appropriate advice in support of that. That was the theme of the last group of amendments. There are also duties to engage with their health and well-being boards to find out what local needs actually amount to, to prioritise the strategies that are required to address them and to develop those strategies and plans accordingly. The Government believe that local bodies have greater knowledge and understanding of local health needs and that they are best placed to assess the need for services, including rehabilitation and support services within their areas. Moreover—and this is the most fundamental point—under the arrangements set out in Healthy Lives, Healthy People: Consultation on the Funding and Commissioning Routes for Public Health, local authorities will be responsible in the future for commissioning services to support people to recover from dependence in line with local need. In terms of the work of my department, I can again confirm to the noble Earl that a great deal of thought and effort is being given to this important issue. As he knows, we are working with a range of experts in doing so. If I may, I would like to write to him to set out fully our future plans in this area. I hope he will understand the stance that we have taken on this. Having received my letter, he is very welcome to meet me, if he would like to, to enable me to update him on the work that we are doing on this important issue.