The following amendments have been selected: amendments 1 and 2 in the name of Paul Davies.

We move on to the next item on the agenda, which is the debate on the substance misuse delivery plan of 2016-18, and I call on the Minister for Social Services and Public Health to move the motion—Rebecca Evans.

Motion NDM6082 Jane Hutt

To propose that the National Assembly for Wales:

Notes the Welsh Government priorities for Substance Misuse as set out in the Substance Misuse Delivery Plan 2016-18.

Motion moved.

Thank you. I’m pleased to open today’s debate proposing that the National Assembly for Wales notes the Welsh Government priorities for substance misuse as set out in our new substance misuse delivery plan 2016-18.

The Presiding Officer took the Chair.

Substance misuse is a major health issue that affects individuals, families and communities. The Public Health Wales ‘Making a Difference’ report published in July this year highlighted the scale of the problem of substance misuse, which shows the continued challenges that we face.

The report highlights the threat alcohol misuse poses to public health in Wales, as it’s a major cause of death and illness with high costs to the NHS, society and the economy. For example, alcohol is associated with more than 6,000 cases of domestic violence each year. As well as rising concerns about the impact of alcohol misuse, the fast-changing nature of the drug misuse landscape presents new challenges to policy makers, commissioners, and treatment agencies.

As a Government, we invest almost £50 million annually to deliver the commitments in our 10-year substance misuse strategy, ‘Working Together to Reduce Harm’, which was published in 2008. The Welsh Government approach in our strategy is rooted in a harm-reduction approach, which recognises addiction as a health and care issue, as opposed to one that’s solely related to criminal justice. Our overarching strategy is built around four key aims: preventing harm, support for substance misusers, supporting and protecting families, and tackling the availability of substances and protecting individuals and communities via enforcement activity. Our overall aim is to ensure that people in Wales are aware of the dangers of and the impact of substance misuse in order to help make informed choices and to know where they can seek information, help and support, if they need it.

Since our strategy was launched, we have seen sustained improvements in waiting times for drug and alcohol treatment and other outcomes for this vulnerable and hard-to-reach group, and it’s vital that we maintain this momentum. We cannot make the progress that we want without the support and the expertise of others. We therefore work in strong partnership with the third sector, health, local government and the criminal justice agencies. The latest delivery plan sets out in detail the specific actions that will be undertaken over the next two to three years in support of our strategy to make the further progress that we want to make on this challenging and fast-moving agenda.

This is a plan that has a greater emphasis on prevention, tackling alcohol-related harm and recognising the role that wider primary care services can make to detecting and responding to individuals dealing with substance misuse. Working in partnership will be critical to successful implementation, and our seven area planning boards are key to taking this work forward as they continue to commission and deliver the range of services in their local areas relating to tackling substance misuse.

This plan continues to build on the range of awareness-raising initiatives that we have established, such as DAN 24/7, our bilingual substance misuse helpline. We have also rolled out a national training programme on new psychoactive substances across Wales to ensure that professionals who come into contact with individuals using or considering using these substances have the knowledge they need to provide the necessary information, advice and support.

Early intervention and education are critical in this agenda, and through our all-Wales schools liaison core programme, we are working with the four Welsh police forces to educate pupils on a range of personal and social issues, including substance misuse, domestic abuse and sexual exploitation. The programme is run in all primary and secondary schools across Wales and is well regarded by headteachers and others in local areas.

Recent developments suggest a growing concern about the use of image and performance-enhancing drugs. Therefore, education relating to the implications of using these drugs is also important, particularly in relation to sport. We’ll be holding the first cross-agency symposium to highlight the problem of the misuse of drugs in sport and the wider related social issues shortly. This will also link to the wider work Public Health Wales is undertaking, which is aimed at evidencing the nature, scale and harms associated with steroids and image and performance-enhancing drugs.

Following extensive engagement with stakeholders during its development, our delivery plan was formally consulted on between January and March of this year. Forty-nine responses were received from a wide range of organisations, and these have informed the final plan that you see before you today. As the plan illustrates, we are clear about the contribution that tackling substance misuse can make to achieving the goals set out in the Well-being of Future Generations Act, and we have developed this latest plan very much in line with that groundbreaking legislation. High-level substance misuse outcomes have been mapped against the relevant goals so that the links are clear and explicit.

The plan is underpinned by the principles of prudent health and care, and this is an area that can demonstrate good examples of prudent healthcare in practice. I am grateful to those Members who have previously served on the Health and Social Care Committee, who carried out two inquiries on substance misuse, and the new plan incorporates all the recommendations from those inquiries.

As a result of the collaborative and inclusive partnership approach taken in developing the plan, responses to the consultation were very positive. The vast majority of respondents agreed with the outcomes described under each of our aims. A number of responses highlighted areas that could be addressed in order to further strengthen the delivery plan, and an example of this is the need to ensure that services are accessible for all potential service users, including those with protected characteristics. In terms of reducing harm, some felt that there was a need to ensure that further work is undertaken to train all professionals who come into contact with the general public to recognise the signs of substance misuse issues. Also, addressing the cultural change needed to reduce harmful drinking was seen by some as a priority. Respondents also commented that more action was needed on preventing a drug overdose in the first place. We have rolled out our naloxone programme, but it was felt that other harm-reduction approaches should also be promoted, such as helping people who misuse substances to understand the risks, the signs of overdose, the dangers of poly drug use, and encouraging the use of less risky drug administration methods. These and more other helpful suggestions were received during the consultation process and they have been incorporated in order to further strengthen our plan.

So, to conclude, I commend this motion to the Chamber and I support the amendments tabled by Paul Davies. On the first amendment, I agree that we must recognise the problems inherent in the delivery of substance misuse services, given the complexities of supporting somebody with these issues. This is illustrated by the fact that not all individuals may be free from drugs or alcohol at the end of their treatment, as, for many, it will be a lifelong battle.

On the second amendment, we will be reflecting on the latest data. We use and continue to use the data from the substance misuse national database in order to work with area planning boards to put in place plans to address any concerns or areas of development. Therefore, we’re also pleased to support this amendment.

So, I look forward to contributions in the debate. Diolch yn fawr iawn.

I have selected the two amendments to the motion. I call on Mark Isherwood to move amendments 1 and 2 tabled in the name of Paul Davies.

Amendment 1—Paul Davies

Add as new point at end of motion:

Recognises the problems inherent to the delivery of substance misuse treatment services across Wales, given that the latest statistics from the Welsh National Database for Substance Misuse show that only 13 per cent of individuals were deemed substance free by the end of treatment from all referrals to drug and alcohol agencies in Wales.

Amendment 2—Paul Davies

Add as new point at end of motion:

Calls on the Welsh Government to reflect on the latest data on NHS Wales Substance Misuse and bring forward proposals that will ensure substance misusers access timely and effective treatment.

Amendments 1 and 2 moved.

Diolch, Lywydd. Our amendments 1 and 2 reflect the latest statistics from the Welsh national database for substance misuse, showing that only 13 per cent of individuals were deemed substance free by the end of treatment from 6,084 referrals to drug and alcohol agencies in Wales. The number of deaths from drug-related poisoning and drug misuse hit record levels in England and Wales last year. Deaths from all drug poisoning were up 65 per cent in England, but 153 per cent in Wales since records began in 1993. Whilst drug misuse deaths in England rose 192 per cent, the increase in Wales was 409 per cent.

Alcohol also remains a major cause of death and illness in Wales, with around 1,500 deaths attributable to alcohol each year—4.9 per cent of all deaths. Mortality rates are higher in Wales than in England.

I was pleased to introduce North Wales-based CAIS drug and alcohol rehabilitation charity to Living Room Cardiff, the community-based recovery centre for Cardiff and south Wales, and then to speak at their official merger launch to become one of Wales’s largest addiction therapy providers here in 2014.

The Welsh Government’s substance misuse delivery plan 2016-18, which we are debating today, does acknowledge that the partnership working between the statutory and third sectors is at the heart of delivering its key aims, but this will only happen when this is co-produced, designed and delivered with the third sector. Area planning boards were established some five years ago to oversee commissioning and delivery of substance misuse services. The governance for these bodies was never properly established and they’ve evolved in very different ways, leading to variations in practice across Wales. Latterly, the divergence has grown, with some all but disappearing, in favour of statutory agency leads. The third sector, by omission, is now largely absent from strategic planning.

The delivery plan is fairly silent on area planning boards, and we therefore need to know the Government’s view on the expected governance arrangements, inclusivity of membership, joint commissioning and plans for the future.

The Welsh Government accepted the recommendation in the health committee’s 2015 inquiry into alcohol and substance misuse that it maps the provision of detoxification centres in Wales, identifies gaps and sets out how these will be addressed. The then Minister also said that this delivery plan will consider what further actions are needed centrally to support tier 4 residential detoxification and rehabilitation services nationally. However, the delivery plan instead talks only of local health boards and local authorities working with partners to set out a plan on how they intend to address gaps in services, with tier 4 listed last. In fact, it’s nine years since the Welsh Government-commissioned report on substance misuse tier 4 treatment services in Wales was leaked to me and made public after they tried to bury it. It identified numerous reports of people reoffending, so as to be able to be detoxed in prison, and of hospital admissions because of the unavailability of in-patient detoxification and residential rehabilitation. The report called for a substantial increase in capacity, for a central referral unit for the whole of Wales and for the development of three drug and alcohol detoxification and rehab units across Wales, working with third sector providers.

A further report in 2010 reinforced this message and the then Welsh Government stated that it was taking forward work on development of the three units. Instead, the Welsh Government residential detoxification cuts a decade ago remain in place, and although a Wales tier-4 framework was produced after the previous health Minister issued a letter advising commissioners to support Welsh facilities, the number of rehab places in Wales has significantly reduced over the last five years. So, what is the Minister’s view on this, and, given that 50 per cent of the residential rehabilitation placements funded were in facilities outside Wales, how is the framework launch in 2015 affecting this?

The health committee’s 2015 inquiry described silo working, and only last week, the chair of the north Wales safer communities board told me that too much is being spent on firefighting and not enough on intervention and prevention, where approximately 75 per cent of those with substance misuse problems, including over 50 per cent with alcohol problems, also have mental health problems, but the continuing gaps in dual-diagnostic provision I was highlighting a decade ago mean that the revolving door persists, with huge consequent costs for health and social services and criminal justice. Unless these issues are addressed at last, this delivery plan will remain the latest chapter in a long history of betrayal.

Substance misuse is an issue that takes its toll on individuals, on families and on communities across Wales. It affects the health of those who misuse substances—or worse, of course: the number of deaths in Wales as a result of drug misuse has trebled in 20 years. There’s also an effect on the economy, of course, in terms of loss of income for individuals and businesses through employee absence. The burden on the NHS is a heavy one evidently, but also for social services and the criminal justice system. And local authorities, through their cleaning work every Sunday morning if nothing else, also shoulder a very heavy financial burden.

Compare and contrast that cost with those who profit, be they those who sell drugs illegally or, more out in the open, if you will, the drinks industry, which is a lobby trying to persuade Government not to take steps to tackle misuse by setting a minimum unit price for alcohol, for example. Even though this lobby has succeeded in persuading some political parties in the Siambr, we must not shift our focus from the need to tackle substance misuse.

Many initiatives have been put forward by the Government on this issue, of course, but we must evaluate their success against the results, against what has been achieved. Unfortunately, the mortality rates as a result of alcohol misuse have remained the same for a decade. There has been an increase in the number of deaths due to drug misuse. We heard a number of figures quoted by Mark Isherwood. It’s worse in some areas than others. I was reading an article in the ‘South Wales Evening Post’ published over the weekend raising concerns about the situation in that particular city. So, the facts show us, certainly in terms of preventing loss of life, which has to be a priority, that the previous strategy has failed and that it therefore needs to be updated.

Why are we failing to make progress on this issue? The lack of full powers with regard to alcohol is certainly one barrier. We in Wales cannot put a series of measures in place, such as setting a minimum unit price, preventing advertising or changing the drink-drive limit, for example, as a strategic effort across Government to tackle that problem.

The Welsh Government’s leadership has not been sufficiently robust in implementing strategies. Provision has varied too much from area to area, especially in terms of residential services, services exclusively for women and so on. These are not just Plaid Cymru’s findings either—I remind you of that; these are the findings of the previous health committee too. So, I’m very pleased that that committee’s recommendations have been accepted by the Welsh Government and that the recommendations have at least influenced this new scheme that we have before us.

I have a few comments and questions on the scheme, the first of which echoes what we heard from Mark Isherwood. The scheme involves an intention to map substance misuse services, but it doesn’t mention residential services specifically. So, will the Minister please give an assurance that the mapping process will include this and make a commitment to fill the gaps that exist in terms of service provision at present? The scheme mentions, and indeed boasts about, spending around £50 million annually on substance misuse services, but given the size of the problem and the implications for public spending on other services from not tackling the problem, does the Minister genuinely feel that that amount is sufficient to lead to the decrease in drug misuse that we all wish to see?

Even though I welcome the fact that the action plan puts forward indicators to measure success or failure, I would have wished to see greater detail in terms of targets, for example. There is no intention to state how quickly we should see improvement and no dates set for hitting targets. We would want to see more specific targets and timetables in place, and I would welcome the Minister’s comments on that.

Finally, we note that the scheme fails to mention the need to ensure that more powers are available to the Welsh Government to develop a more holistic scheme—the lack of powers that I referred to earlier. Where there is clear evidence that the weak devolution settlement that we have harms the people of Wales physically—the previous health committee agrees with this, by the way—then we in Plaid Cymru strongly believe that it should be the Welsh Government’s duty to press for the powers that we need—to demonstrate the limits of the current settlement and draw attention to the true costs to the living standards of our citizens, as well as the financial cost, of poor devolution. It is worth noting, of course, that we’re having this debate here today, the day after the House of Commons failed to take the opportunity to strengthen the settlement in a genuinely meaningful way with the new Wales Bill.

The Plaid Cymru manifesto earlier this year contained a commitment to establish a network of residential centres for those who misuse alcohol and drugs, more training for NHS staff and a minimum unit price. You can rest assured that Plaid Cymru would not tolerate a poor devolution settlement and we will always campaign to ensure that Wales receives the powers it needs to deal with important issues such as drug misuse. Of course, we will—

You need to draw your comments to a close.

Thank you. We note this report today and we’ll support the amendments put forward by the Conservatives. I look forward to hearing the Minister’s response to some of my questions, but primarily I look forward to looking back at success in this field after too much failure in the past.

I welcome the opportunity to take part in this important debate. Substance abuse affects every section of our society and communities. Thirty four per cent of men and 28 per cent of women drank more than the recommended limits on at least one day during the last week. Adults living in households in the highest income bracket are twice as likely to drink heavily as adults in the lowest income bracket. Older people tend to drink more frequently than younger people, and young people are more likely to take drugs than older people. One in 16 to 24-year-olds have taken illicit drugs during the last year compared with just over one in 50 in the 55 to 59-year-old bracket. Middle-aged males are more likely to be addicted to prescription-only painkillers, and women are more likely to be addicted to over-the-counter medication.

The number of people being referred for treatment for substance misuse has risen sharply in the last 12 months, and the number of drug-related deaths is at a record high. It is therefore essential that we have the right policies in place in order to reduce the harms associated with substance misuse. UKIP welcomes the Welsh Government’s latest delivery plan, particularly the emphasis given to tackling co-occurring substance misuse and mental health issues. Mental health teams are reporting a rise in the numbers of patients taking new psychoactive substances, and NPS use is endemic in the prison population, where up to 90 per cent of prisoners have some form of mental health issue. There is a problem with the revolving door, and these issues don’t seem to be resolving as quickly as we’d like.

The decision by the UK Government to outlaw so-called legal highs is extremely welcome, but we must do more to advertise to the public the dangers of NPS. Cabinet Secretary, what is the Welsh Government doing to raise awareness about the harms associated with new psychoactive substances among the public? Your delivery plans involve training for staff, and, whilst this is welcome, we need to educate the public if we are to reverse the increasing use of NPS and its associated harms. We also need to work with the Ministry of Justice to tackle the influx of NPS in our prisons and ensure that we can deliver adequate mental health care for Welsh prisoners. We hope that the delivery of your substance misuse strategy matches its intentions, and we hope that the strategy will reverse the rise in substance misuse and that the number of drug-related deaths decreases. Thank you.

An ONS survey found this year that almost 14 per cent of adults in Wales admitted to drinking the same amount of alcohol in a day as experts advise you shouldn’t exceed in a week. So, strategies to deal with substance misuse are to be welcomed. The Government has gone to great lengths to control or make unlawful all sorts of substances, including tobacco. However, the last Labour Government in Westminster saw fit to do the opposite with alcohol, one of the most potentially damaging and addictive substances, and liberalise licensing laws to such an extent that alcohol is now available on practically every corner. Walk down the high street into the supermarket, corner shops and even petrol stations and it’s there, available 24/7. The police didn’t want the liberalisation, communities didn’t want it and responsible pub landlords didn’t want it. The only people who did were the drinks companies, the chain pubs and of course Gordon Brown at the Exchequer. So, for the sake of the tax take, a Labour Government, the fellow travellers of many of the people currently sitting in the Welsh Government now, created a twenty-first century version of Gin Lane, forgetting that the parts of the community likely to suffer the most were the children of alcohol-dependent parents. We should remember this when the Welsh Government are patting themselves on the back over how they are dealing with the symptoms of that insane liberalisation.

We can’t put the egg back in its shell for the people who are damaged by their own or others’ alcohol abuse, but we can find ways to make alcohol much less accessible. So, what is the Welsh Government doing in Wales and at Westminster about this? Thank you.

And I call on the Minister to reply to the debate.

Thank you very much, Presiding Officer. I’ll do my best to answer as many of those points as I can in the time remaining to me. Mark Isherwood began by talking about reducing drug-related deaths, and every single drug-related death is of course tragic, but the numbers are so low that we have to be very cautious about interpreting year-on-year fluctuations in those figures. We are looking very closely with Public Health Wales at the latest statistics. We believe that the increased purity of heroin and the fact that older people are taking it, who might already have some pre-existing conditions, might be a factor in this, and also poly-drug misuse—so, taking heroin alongside other drugs as well makes things much more complicated. We do continue to fund the naloxone programme, which is the drug that temporarily reverses the effects of opiate overdose, across Wales and in our prison settings as well, and we’re currently working with all custody suites and accident and emergency departments to roll it out even further as well, because this is an initiative that has been used by hundreds of people already and I do believe is saving lives.

You refer to the importance of co-production, and I’m completely with you there on that. Particularly, actually, we have to co-produce with service users themselves. So, our service user framework requires that area planning boards actively involve service users as well, because we believe that they have the lived experience and the expertise in order to help us deliver successful substance misuse services.

Mark Isherwood and Caroline both referred to co-occurring mental health problems alongside substance misuse. Our substance misuse treatment framework, which is called ‘Meeting the needs of People with Co-occurring Substance Misuse and Mental Health Problems’, has been revised to encompass just that and encompass the key developments that have taken place since its first publication—talking about things like poly drug use and new psychoactive substances and so on as well.

Mark Isherwood said that intervention and prevention are absolutely key and he’s right there. Our all-Wales school liaison programme operates across all of our primary and secondary schools in Wales and this is a crucial part of our strategy. We regularly review the content of that to make sure that it’s fit for purpose and reflects the current trends in drug use, focusing currently on new psychoactive substances and educating children in schools about the dangers of that.

Both Rhun ap Iorwerth and Michelle Brown mentioned minimum unit pricing—or mentioned alcohol, and Rhun mentioned minimum unit pricing—as a way to deal with the problem of alcohol misuse, because there’s significant evidence that the price of alcohol actually matters and our proposal to introduce a minimum unit price for alcohol is a high-impact proposal for tackling the health harms associated with alcohol misuse. It would set a floor price for alcohol, meaning that it couldn’t be sold below that level. We know that this would help us deal with the problem of alcohol misuse in Wales, but there are problems. There’s a similar proposal currently in the courts in Scotland, so we’re watching that very closely to understand what the powers might be here.

The further concern that Rhun outlined is that the draft Wales Bill also includes, as a reserved power, the sale and supply of alcohol, which would provide a major obstacle to us achieving our ambition. So, we’re looking at the timescales involved in this to see what might be possible in terms of our public health Bill and the Wales Bill there. But I share your concerns. You raised the issue of powers more widely, so that would include alcohol licensing. Welsh Government position remains as it always has been—that the licensing and sale and supply of alcohol and provision of entertainment and late-night refreshment should not be a matter that is reserved to the UK Government. We believe and have advocated strongly that the consideration of public health should be a consideration of the Licensing Act 2003. We continue to press the UK Government for the devolution of alcohol licensing powers to the Assembly.

Caroline mentioned older people. Our substance misuse strategy fully recognises the importance of tackling substance misuse amongst older people and including those who are dealing with alcohol issues. We’ve published some specific guidance for practitioners to improve the identification of and access to substance misuse treatment services for older people. We’ve also included alcohol in the online health checks that we have for the over-50s. I’ve asked the advisory panel on substance misuse to look at substance misuse issues in an ageing population as well. That work will bring in specialists in substance misuse together with experts on older people, and that will report in the near future as well.

You also mentioned prescription and over-the-counter medicines and how they are often abused. We’ve developed an e-learning package for pharmacy staff to help them identify and offer brief interventions to people who are misusing prescription and over-the-counter medication. Prescribing data are made routinely available to local health boards and GPs in Wales, allowing prescribing practices to be monitored. So, this supports local health boards in identifying variations and changes in practices and that helps target support to improve the safety and efficiency of prescribing as well.

New psychoactive substances were referred to in the debate, and, of course, the UK Government’s Act, which we were broadly supportive of, came into force on 26 May this year. The Welsh Government has taken a range of awareness-raising initiatives through our service DAN 24/7. We’ve also created support materials for parents and carers regarding NPS as well and also considered all of the recommendations made by the Health and Social Care Committee’s report into this. That’s very much been incorporated into our plan. It certainly informed the thinking on that. Following the Health and Social Care Committee’s report, a national training programme has also been developed and provided to stakeholders in Wales. I’m also considering e-learning modules on NPS and other drugs so that the prevention of and response to substance misuse can be more integrated into the mainstream of our healthcare provision in Wales.

Finally on this, we know that having a suitably skilled and knowledgeable front-line workforce is key to improving education and the prevention of risks associated with NPS. So, a bursary scheme is also available via the Welsh Government to further develop the workforce.

So, in concluding, I hope that Members will join me in thanking all of our dedicated stakeholders who have worked with us on this agenda. It’s a challenging agenda, and their hard work, commitment and compassion is vital as we aim to tackle substance misuse across Wales. Thank you.

The proposal is to agree amendment 1. Does any Member object? If not, amendment 1 is agreed in accordance with Standing Order 12.36.

Amendment 1 agreed in accordance with Standing Order 12.36.

The proposal, therefore, is to agree amendment 2. Does any Member object? There are no objections, and therefore amendment 2 is agreed in accordance with Standing Order 12.36.

Amendment 2 agreed in accordance with Standing Order 12.36.

The remaining proposal, therefore, is to agree the motion as amended.

Motion NDM6082 as amended

To propose that the National Assembly for Wales:

1. Notes the Welsh Government priorities for Substance Misuse as set out in the Substance Misuse Delivery Plan 2016-18.

2. Recognises the problems inherent to the delivery of substance misuse treatment services across Wales, given that the latest statistics from the Welsh National Database for Substance Misuse show that only 13 per cent of individuals were deemed substance free by the end of treatment from all referrals to drug and alcohol agencies in Wales.

3. Calls on the Welsh Government to reflect on the latest data on NHS Wales Substance Misuse and bring forward proposals that will ensure substance misusers access timely and effective treatment.

Does any Member object? There are no objections, therefore the motion is carried.

Motion as amended agreed in accordance with Standing Order 12.36.

That brings today’s proceedings to a close.

The meeting ended at 18:21.