I move amendment 2, which regrets that the 2017 annual report for the Welsh Government's 10-year substance misuse strategy, 'Working Together to Reduce Harm', shows that there has been an increase in both alcohol-related and drug-related deaths in Wales. Whilst this report also claims good progress on providing quicker treatment, our amendment 2 also quotes Welsh Government statistics showing that the number of people completing treatment substance free has fallen—in fact, down in April to June on the previous quarter to the lowest level for a year—and that fewer people are starting treatment within 20 days since their referral than two years previously. Cases closed as a result of death in April to June was the highest on record; alcohol-specific deaths in Wales rose 7 per cent in 2016—the highest number since 2012; alcohol-related deaths rose 9 per cent—the highest number since 2008. It is therefore concerning that the total number assessed by specialist substance misuse providers fell by 5 per cent and that the total number starting treatment was down 4.6 per cent. Hospital admissions relating to the use of illicit drugs rose by 3.8 per cent after 2015-16, and drug misuse deaths in Wales rose 14.3 per cent in 2015 to the highest recorded levels since comparable records began in 1993.

Our amendment 3 calls on the Welsh Government to increase capacity in tier 4 in-patient detoxification and residential rehabilitation services, recognising that this is not an alternative to recovery-focused services within the community. I say that, having been championing the recovery model here since the days when Welsh Government still prioritised medical management and maintenance treatments over recovery for addicts. In a recent exchange of correspondence with the previous public health Minister regarding tier 4 in-patient detoxification and residential rehabilitation, she stated that more recovery-focused services have reduced the need for residential rehabilitation services. In reality, they should complement each other. In an equivalent debate almost a decade ago here, I referred to the loss of Welsh beds that they have in one detoxification unit in Wrexham, and to the independent review of detoxification and residential treatment in north Wales, commissioned by the then Minister, who anticipated that this would endorse a switch to detoxification in the community. Having been buried, this report was leaked to me and made public. It found that the whole service, including in-patient beds, was underfunded. When I put this to that Minister, she would not accept it.

A further independent review, looking at substance misuse tier 4 treatment services in Wales, was also buried, leaked to me and made public. 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. It called for a substantial increase in capacity and for the development of three drug and alcohol detoxification and rehabilitation 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, it is understood that the Welsh Government residential detoxification cuts a decade ago remain in place, and that the number of rehab places in Wales has significantly reduced over the last six years. 

In October, the Minister told me she had been advised that a decline in the demand for residential rehabilitation places was primarily due to the eligibility criteria being strengthened in line with the National Institute for Health and Care Excellence guidelines. However, as NICE guideline 115 states,

'the more severe and less socially stable fare better in inpatient'.

The sector tells me that numbers are down because there are fewer residential rehabilitation places in Wales, and people are being moved into the community without evidence of need. Regarding the Welsh Government's substance misuse residential rehabilitation framework, Wales has only seven places at Ty'n Rodyn in Bangor and approximately 20 at Brynawel near Cardiff, the latter including alcohol-related brain damage.

Since the framework commenced, only eight of 24 referrals to Ty'n Rodyn from within Wales arrived through the framework. Regarding joined-up health and social care, Brynawel is continually seeing the negative consequences of funding disputes between local authorities and health boards. Meanwhile, residential rehabilitation placements outside Wales last year went to three organisations on the framework and six organisations outside it.

Yes, the potential of community-based treatments for dependent drug users and drinkers with relatively less-complex needs must be maximised, but we also need investment in tier 4 interventions, their integration with the other tiers of alcohol and drug treatment, and enhanced links between them and community based services, aftercare and wraparound services. To do otherwise will cost more lives and more money.