The following amendments have been selected: amendment 1 in the name of Rhun ap Iorwerth, and amendments 2 and 3 in the name of Paul Davies.

The next item is the debate on tackling substance misuse, and I call on the Cabinet Secretary for Health and Social Services to move the motion—Vaughan Gething.

Motion NDM6559 Julie James

To propose that the National Assembly for Wales:

Notes the progress being made in tackling the harms associated with substance misuse, as highlighted in the Welsh Government’s Substance Misuse Annual Report and Forward Look.

Motion moved.

Good afternoon and thank you, Llywydd. I'm pleased to open today's debate and move the motion before us on tackling substance misuse. I'll comment initially about the amendments and then go into my remarks—broadly about where we find ourselves in Wales today.

I'm happy to confirm that we'll support amendment 1 from Plaid Cymru—I'll mention that later on. On amendment 2, we won't be able to support this, because there's a factual disagreement about the assertions made. Actually, the latest data from NHS Wales Informatics Service show that the number of people completing treatment substance free actually increased, not decreased, as the wording sets out—there was an increase from 3,288 in 2015-16 to 3,604 people who completed their treatment substance free in 2016. I do accept that the other elements in the amendment are accurate.

I'm also happy to accept the third amendment put forward by the Conservatives. We agree that residential rehabilitation and in-patient detoxification play an important role in helping people to secure their long-term recovery, albeit these are not alternatives to community-based rehabilitation, which also plays an important part.

Substance misuse itself is, of course, a major health issue that affects individuals, families and communities. As well as the rising concerns that we have over the impact of alcohol misuse, the ever-changing nature of drug misuse presents us with new and changing challenges to both policy makers, commissioners and treatment agencies. This Government continues to invest almost £50 million annually to deliver the commitments in our latest substance misuse delivery plan that runs up to 2018.

Our plan remains rooted in a harm-reduction approach. That is why we recognise substance misuse as a health and care issue and not solely a criminal justice issue. That is why we are happy to accept amendment 1. The Welsh Government's overall aim is to ensure that people in Wales are aware of the dangers and the impact of substance misuse, and to know where they can seek information, help and support if they need it. 

There are considerable challenges associated with the fast-changing picture, supporting some of our most vulnerable citizens. However, we are making real progress. In 2015-16, 83.3 per cent of people who started treatment were seen within 20 working days. In 2016-17, we saw 16,406 people start treatment, and 86.7 per cent of those people were seen within 20 working days—a material increase in the speed of treatment. And I would like to take this opportunity to thank all of those front-line staff who provide those services for that achievement.

We're also seeing improvements in treatment outcomes—77 per cent of people reported a reduction in their substance misuse following treatment in the last year, compared to 69.2 per cent in 2013. Now, whilst these improvements are welcome, our annual report highlights worrying increases in both alcohol and drug-related deaths. And this emphasises how important it is that tackling these issues remains a priority for this Government and our partners, as alcohol and drugs remain a significant cause of death and illness, and, indeed, avoidable death and illness. The data show the rise in alcohol-related deaths in 2016 and that reinforces our need to take action. That is why our Public Health (Minimum Price for Alcohol) (Wales) Bill is a crucial part of responding to this major public health issue. And that legislation, debated in this place last month, will focus on reducing alcohol consumption amongst hazardous and harmful drinkers. And it will also reduce the negative impact of alcohol misuse on hard-pressed public services, both devolved and non-devolved.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Minimum unit pricing will form part of, and complement, our wider substance misuse work. We are already working to tackle the excessive consumption of alcohol through better education, prevention and treatment services to support the most harmful of drinkers. We'll continue to work with the families, of course, of those who misuse alcohol. And we're also working on a number of areas to tackle the recent increases in drug-related deaths. Part of that is our groundbreaking WEDINOS project, which continues to play a key role in the analysis of a range of drugs. So, testing those new substances enables us to examine the chemical compound of the substance, but then crucially to disseminate widely the risk factors involved when individuals take them, and to date WEDINOS has received over 7,000 samples from across the United Kingdom.

Now, the distribution of naloxone, which is a drug that temporarily reverses the effects of an opiate overdose, has been a key strand in our harm-reduction approach, and we think it was a real and an important factor in the reduction in drug-related deaths between 2011 and 2014 here in Wales. So, we're placing even greater emphasis on our naloxone work to help the upward trend in uptake. In total, over 15,000 kits have been distributed throughout Wales since 2009, with over 1,600 reported uses. So, naloxone is available in every community drug treatment service and in all prisons in Wales. We will continue to work closely with areas in Wales to further expand the presence of naloxone, especially in relation to those who are not currently engaging in treatment, and that's particularly important when we consider that the number of drug-related deaths occur amongst those who have not accessed our substance misuse services.

For example, officials in my department are working closely with Dyfed-Powys Police to commence the distribution of naloxone kits within custody suites. But the complexity of this agenda can be seen when we consider the rise in other substances, such as the image and performance-enhancing drugs, and we know there are major pressures today in terms of society and its view of body image that continue for both men and women. The Welsh Government, working with Sport Wales, Public Health Wales and other partners, held a national symposium earlier this year on the misuse of image and performance-enhancing drugs and its impact on sport and the wider community, and a group has now been established to take forward and consider how to respond to the recommendations of that symposium.

We also continue to support DAN 24/7, our free, bilingual substance misuse helpline, which provides a single point of contact for anyone in Wales wanting further information or help relating to their drug or alcohol issues. And in the last year, DAN 24/7 responded to over 4,000 calls, and the website had over 75,000 hits. So, DAN 24/7 has also formed part of numerous information campaigns over the last three years that have been targeting specific areas of challenge. The most recent campaign—I hope you've seen it in the current and ongoing autumn rugby international series—is the It's Nothing Trivial campaign that focuses on the dangers of mixing alcohol and drugs.

Now, in terms of recovery from substance misuse and reintegration into society, being able to secure employment is hugely significant. That's why I'm delighted that we've secured £11.6 million from the European social fund to run a substance misuse out-of-work peer mentoring service, and the match funding that I have agreed for that service means that, in total, we'll invest £17.3 million in the programme until summer 2020. And that programme aims to help over 14,000 people over 25 who are long-term unemployed or economically inactive to recover from mental ill health and/or substance misuse back into employment, or those age 16 to 24 who are not in education, employment or training. And in the first year of that programme, over 1,500 participants have enrolled in the service and benefited from it.

We do know that substance misuse is a major cause for people being sick, losing jobs and feeling unable to get in to work. So, this programme joins together some of our key goals around health and employability, and it contributes to our commitment to support people break down the barriers that ill health places upon employment. I hope that's helped outline some of the measures this Government is already taking, but also the open-mindedness and understanding we need to recommit ourselves to this area of work and consider what is most effective and active here in Wales, as we move forward, as I say in an area that is constantly changing and is a constant challenge in each community across the country.

Thank you very much. I have selected the three amendments to the motion and I call on Dai Lloyd to move amendment 1, tabled in the name of Rhun ap Iorwerth. Dai.

Amendment 1 Rhun ap Iorwerth 

Add as new point at end of motion:

Believes that substance misuse is a public health issue not a criminal justice issue.

Amendment 1 moved.

Diolch yn fawr, Dirprwy Lywydd. I shall be, as the DPO has outlined, addressing the Plaid Cymru amendment that specifies that drug and alcohol misuse and substance misuse generally is a public health issue, and not a criminal justice issue.

Now then, I've been a GP for a very long time, and addiction is a constant issue. Some people have had horrendous lives. They have suffered neglect as children, child abuse, sexual abuse. They've been denied love. Sweet little babies in my baby clinic over the years will become increasingly brutalised as they grow up in a terrible existence. No wonder that people want to blot out the pain, find any buzz anywhere, in alcohol and in drugs—legal drugs, illegal drugs, prescribed drugs, non-prescribed drugs—any buzz, anywhere, to escape the cold reality in intolerable conditions, unable to escape the abuse, the hatred and the loathing.

On top of that, tragic accidents and incidents can happen. With no family support or love, all of that heaps hurt on our people. Throw into the mix mental health issues on an increasing scale, with people reacting in an unpredictable manner, with hostility and violence, because they know no other way.

As a health professional in the field, you are presented with enormous challenges that stretch you to the utmost. I pay tribute to all of those working in the field this afternoon. It is extremely demanding and challenging, because we are talking about dealing with people with chaotic lives, with no order whatsoever. They're not able to help themselves, frequently, with overwhelming financial challenges and homelessness and rough sleeping as constant companions to the alcohol and the drug addiction.

And how do we respond as a society? With kindness, tolerance, willingness to help, to explore the underlying issues that led to this current chaos, or does society respond by marginalising such people? 'They are addicts, they have brought it on themselves.' Really? Arresting them—how is that going to help? How about finding out that individual's story, the tragedy, the hurt, the family schisms, the lack of forgiveness, the self-loathing, the self-harm and, yes, the attention-seeking behaviour in people who have seldom had love or attention showered upon them ever in their lives?

There is much excellent work being done. Like Jenny Rathbone, I'm a trustee of the Living Room, Cardiff, an alcohol rehabilitation and drug rehabilitation centre. As well, I know the good work of the Welsh Centre for Action on Dependency and Addiction and others in Swansea, and the Brynawel alcohol rehabilitation unit near Llanharan and many, many more—excellent work in the most trying of circumstances.

But much more needs to be done, has to be done in a public health view, exploring the real issues, counselling, dealing with not just the chemical withdrawal, but with the psychological withdrawal and the social changes that have to happen, and replace the alcohol or the drug with a less destructive coping mechanism for life. Yes, tackling homelessness, finding meaning in life, finding that life is precious, finding that each second can be memorable, forming relationships again, finding belief in oneself—all of these are long-term projects—and treating the mental health issues, not just the short-term chemical-weaning fix with the inevitable relapse.

In that context, how about devolving policing, probation and criminal justice so that the revolving door of reoffending can truly be tackled by the co-ordination and integration of services that are now divided between non-devolved and devolved? The devolved services of health, mental health, drugs and alcohol services, housing, education and training, truly working together with policing and probation and the courts—that would be great.

How about being innovative on top of that, as well, by piloting safe-injection harm-reduction centres, with medics like myself injecting clean heroin in a clinical environment, with gradually decreasing doses and clean needles to prevent blood-borne viruses spreading? That's innovative for you. It works in other countries, stops people dying, truly tackling addiction as a public health issue. Leave your prejudices behind. Yet, still, the hurt goes on. Diolch yn fawr.

Thank you. I call on Mark Isherwood to move amendments 2 and 3, tabled in the name of Paul Davies. Mark. 

Amendment 2 Paul Davies

Add as new point at end of motion:

Regrets that:

a) 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;

b) the number of people completing treatment substance free has fallen; and

c) fewer people are starting treatment within 20 days since their referral than two years ago.

Amendment 3 Paul Davies

Add as new point at end of motion:

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.

Amendments 2 and 3 moved.

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.

I wonder if I could begin by raising some concerns in terms of capital funds' availability, because I know that there are concerns that limitations to capital may result in offices closing and the unavailability of staff to provide a service in particular areas. For example, when leases expire, if there isn't sufficient capital to obtain premises and, indeed, equipment, then there may be a concentration of service provision in particular geographical areas, such as Newport, for example, which is already a focal point for delivery of services for a wider area. But there are concerns that, if that increases, then the level of service provision and the numbers attending service providers in Newport will get to the level where it creates greater concern than already exists in terms of the perceived problems, at least, that too many people trying to access those services in a fairly narrow geographical area creates. So, I wonder if there might be some reassurance in terms of capital funding and the avoidance of those problems.

There was also a concern that changes to homelessness legislation mean that prison leavers no longer have the sort of priority for accommodation that they once had, which has resulted in an increase in homelessness and rough-sleeping. Amongst those prison leavers are those with substance abuse issues. I know that some of the service providers are concerned that that change has resulted in an increase in the problems that people with those substance misuse problems experience—and, by extension, service providers experience.

I also, Dirprwy Lywydd, wanted to talk a little bit about and ask some questions on Alcohol Concern Cymru's advice on good parenting, particularly around alcohol issues, some of which was addressed in the recent Alcohol Awareness Week, and there are fact sheets that are helpful. It seems to me that a lot of parents, as I think Alcohol Concern Cymru reinforce, have a view that it's sensible to introduce their children to alcohol in a responsible way, within a family setting, and that this often happens in continental Europe, for example, having a glass of wine with a meal, and that that's a good way of introducing children to alcohol, rather than them finding out about it, as it were, experiencing it outside the home and perhaps overindulging. But the advice, I think, is that it's actually beneficial if children are completely alcohol free, certainly before the age of 15, and that, if they are introduced to it after the age of 14, for example, then it should be in a very restricted way. Also, there is, I guess, an obvious issue in terms of parents as role models. Parents have to be very careful about how often they indulge in alcohol in front of their children, and be very careful not to overindulge, because I think there's a lot of evidence that, if they fail to guard against those dangers of being a negative role model in these terms, then it does lead to heavy drinking in adolescence, or a greater propensity to heavy drinking in adolescence from their children.

So, those are just some of the issues. Obviously, there's a range of very important issues around parenting and good parenting to avoid alcohol abuse issues and substance misuse issues generally in the future, and we are increasingly about prevention. I just wonder if we could hear a little bit about what the Welsh Government is doing to raise awareness and get positive parenting in place.

Finally, Dirprwy Lywydd, I was at the Newport food festival, which increasingly is a very important event and growing in strength and profile. They had an alcohol-free beer stall, which was very popular, and had a range of different beers, several different beers, which were alcohol free, and, obviously, they were using that to also promote some good messages around avoiding over-indulgence. But they tell me that they're not aware of any Welsh brewers producing alcohol-free beer, although there is a good market for it and that's likely to increase in the future. I wonder whether the Welsh Government Cabinet Secretary might be able to offer a few comments as far as that's concerned. 

When it comes to tackling the impact of problematic substance use on human health, there remains little to celebrate. The Government motion today notes, and I quote, 

'the progress being made in tackling the harms associated with substance misuse.'

But the report actually demonstrates the opposite of progress. The data suggests that a social catastrophe has emerged in our country in recent years, and I don't use that term lightly. A few weeks ago, I raised with the First Minister the fact that drug-related deaths had reached a record high of 168 in 2015. The report that we're debating today shows that, in 2016, drug-related deaths reached a new record of 192. Alcohol-related deaths have also increased to 504, as noted in the amendment in the name of Paul Davies. And these statistics reinforce, I'm sure, what many of us are hearing from drugs organisations, charities, our police and crime commissioners, and from my former colleagues in the probation service. Add it to the homelessness crisis, which, of course, is linked to austerity and benefit reform, and we've got a situation that is creating a harrowing cost to our society, to our public services, to our communities and to human life. 

Many of the drug and alcohol-related deaths are of people who are street homeless. We have the powers over homelessness, of course, but we have to be clear that some of the policy levers needed to fully solve the problematic substance use problem are not yet devolved. The word 'yet' is important here. We need to have the attitude that the powers to address problematic substance use are needed in Wales, and that holding those powers at Westminster is time-limited. This Assembly and the Welsh Government is responsible for public health, for homelessness prevention, and for some aspects of community safety. For as long as justice, welfare and social security powers are held back at Westminster, a fully joined-up approach will be impossible. 

We haven't always had a forward-thinking attitude from the current Welsh Government on the devolution of justice, social security and related fields. But I believe that there is potential to change that. And we must change that, because these figures paint a stark and harrowing picture. Now, I support the Plaid Cymru amendment today—well, I suppose I would, wouldn't I, but because it's a matter of principle that substance use is a public health issue and not a criminal justice issue, and I'm glad that the Government is prepared to support that too. But we need to go further. We need the powers over the criminal justice system to reform drug policies. One thing, for example, that I'd like to see is for people with multiple sclerosis and other conditions to able to legally use cannabis, but we can't do that because we don't have the powers. But, even without the powers over criminal justice, we could still have an impact on reducing the numbers of deaths from drug use if public health solutions were implemented. One of those solutions is being advocated by Arfon Jones, the north Wales police and crime commissioner, who's become one of the most progressive voices on justice policy in Wales. He's earned respect from right across the political spectrum for his stance on treating people who have problems with illegal drugs as humans and not as criminals. 

Only a few years ago, this standpoint was seen as extreme and radical, but now it's becoming accepted in countries right across Europe. Arfon has proposed that suitably located, safe injecting facilities could reduce drug deaths, drug-related crime, and public drug use. This approach has been implemented in Switzerland, combined with other public health measures, and it has reduced drug-related deaths. In Portugal, decriminalisation of some drugs, combined with prevention and treatment programmes, has had a similar effect. Last year, there were fewer drug deaths in Portugal, a country of more than 10 million people, than in Cardiff, Newport and Swansea, with a population of less than 1 million people.

Just as public health measures are seen as the way of reducing harm from alcohol, they should also be used to reduce the harm from drugs. And it's worth noting here that not everyone who drinks alcohol will develop a problem, and the same goes with drugs. And that has to be a starting point, so that we can focus on reducing harm from problematic use.

Let's not look back in years to come and regret more lives, more heartbroken families, because of short-sighted and ineffective drug policies. Let's forge a new, bold approach to this problem in Wales—let's start with saving lives.

I'd like to thank the Welsh Government for bringing forward this important debate today.

Substance misuse ruins lives—not only the life of the person using the substance but the family unit as a whole all suffer. There is no winner in these circumstances, unless the person receives the help that is needed. During my time working in a prison, I can assure you I saw so many different individuals—individuals who had shown promise in their earlier lives—wrecked as a result of what has gone on, of what they've taken. And why their lives have taken such a downward spiral nobody can really know, but what prompted them to feel that their life was so negative is something that does need to be looked into before people are imprisoned.

Last year, in Wales, 192 people died from misuse of illegal drugs, over 11,000 drug-related offences were committed, and nearly 24,000 people were referred to substance misuse services.

Wales is unique in the UK in having a unified substance misuse strategy that tackles drug and alcohol misuse, and the Welsh Government have committed £50 million a year to reduce the misuse of substances at a population level. To a certain extent, the strategy is working. There has been a reduction in the numbers taking illicit drugs and abusing alcohol. However, the number of hospital admissions due to substance misuse are increasing, as are substance misuse deaths.

Hospital admissions related to alcohol misuse have fallen by over 6 per cent over the last five years, yet admissions related to illicit drugs rose by nearly 4 per cent in the past year. In older people, this rose by over 15 per cent.

The current strategy is not reducing substance misuse deaths. In the past year, we saw an 8.9 per cent increase in the number of alcohol-related deaths, and a 13.8 per cent increase in drug-related deaths, the highest level since 1993. The level is much higher than in England.

The Office for National Statistics age-standardised mortality rate for deaths related to drug misuse show that, in England, there were 44.1 deaths per 1 million of the population, while the mortality rate for drug misuse in Wales continued to increase, from 58.3 deaths per 1 million population in 2015, to 66.9 deaths per cent deaths per 1 million in 2016, with Wales now having a higher rate of deaths from drug misuse than eight of the regions of England. This coincides with a huge increase in the misuse of synthetic cannabinoids. Last year, there was nearly a 50 per cent increase in the number of young people being admitted to hospital as a result of cannabinoid misuse.

Welsh hospitals are seeing an average of three people per day admitted as a result of using synthetic cannabinoids such as Spice. My own local health board has taken the drastic measure of giving patients high on Spice a general anaesthetic in order to prevent them biting and kicking staff. These drugs are a growing menace in our communities, towns and cities and we have to improve public education about the harms associated with such drugs.

But, unfortunately, it is not only illicit drugs that cause harm. There are growing numbers of people becoming addicted to and abusing prescription and over the counter medication. Last year, there was an increase in the number of people dying as a result of taking paracetamol, fentanyl and oxycodone. The UK’s leading rehabilitation provider reports that they are treating more people for abusing prescription medication than they do for heroin. One of the main factors contributing to this is believed to be access to pain management clinics. In Wales, there has been a large increase in the number of people waiting for pain management. In the last five years the numbers waiting longer than 36 weeks have risen by a staggering 1,500 per cent. In north Wales patients are having to wait around 72 weeks. This is simply deplorable. The Welsh Government needs to take immediate action to reduce waiting times for pain management in order to reduce dependence on strong painkillers and the associated harms that come from long-term use.

The substance misuse strategy has been reviewed and the Welsh Government is due to receive the final report next month. I hope the Welsh Government see this as an opportunity to tweak this strategy. I look forward to seeing an updated strategy that addresses the numbers of deaths as a result of substance misuse and tackles the new challenges facing us. Diolch yn fawr.

I don't think I'll ever forget the first time I met a 10-year old who was obviously drunk. His breath smelt strongly of alcohol and his behaviour indicated that he—. His risk taking and cockiness was a clear sign of his inebriation. I don't think that minimum alcohol pricing is going to be of assistance to a child like this, because they're never going to be able to actually buy the alcohol themselves, but it does tell you about how, in some households, the level of supervision is so poor that they're not in a position to prevent their child from getting this drunk. Obviously, in many cases, their parents are also addicted to alcohol or drugs and that poses huge questions for any child who finds themself living in a household like that. So, therefore, I just want to point out that it is of concern and we should all be concerned that over 400 referrals last year were for 10 to 14-year-olds.  

I very much welcome the work of the SchoolBeat by the community support officers in schools. We know that alcohol is everywhere, particularly at this time of year, and we obviously have to educate children on how we manage our relationship with alcohol, particularly at this time of the year when alcohol is absolutely everywhere and people are being widely encouraged to abuse alcohol—and well over the guidelines of 14 units—and the fact that throughout the year there are far too many people consuming abusive levels of alcohol and this is reflected in the cancer and liver disease statistics that the health service has to deal with. 

I suppose that one of the concerns I wanted to raise today is the fact that youth workers in my constituency are reporting that young people are much more inclined at the moment to be using drugs rather than alcohol, and, particularly, the consumption of Spice—these synthetic cannabinoids—is a considerable cause for concern, because the cocktail of amphetamines and other substances that drug dealers cook up in their back kitchens, both to increase their profits and to hook a new generation of addicts, must be extremely difficult to track. It's extremely disturbing to see young people in a state of collapse in the city centre of Cardiff and this has been recently well-documented in the local media. One Cardiff user reported that spice had taken over their life: 'It's like heroin; you just lose a grip on reality.'

A Cardiff drug dealer told WalesOnline that, working in Adamsdown or the city centre, they could make £300 an hour. So, you can see the difficulties that the police are working with to try and control this problem. Unfortunately, this, obviously, is reflected in the nearly 50 per cent increase in cannabinoid-related admissions to hospital over the last four years. I strongly applaud the operation of WEDINOS, which is constantly testing the new psychoactive substances, because, clearly, we cannot protect people unless we know what it is they are taking, and we need to be constantly ahead of the game that drug dealers are up to.

Clearly, it's more complicated as a picture than just young people who are desperate to drown their sorrows. As Dai Lloyd has already said, I'm a trustee and director of the Living Room in Cardiff. Addiction isn't just an affliction of the desperately poor. Many Living Room clients are people who are holding down responsible jobs; they're doctors, they're vicars and other professionals who find the emotional demands of the job are encouraging them to use drugs or alcohol as a release from the pressures and the burden of the job that they're carrying.

I absolutely applaud the meticulous and persistent work that needs to go on for anybody who is working in treatment services. I note that there are 15 per cent of people who do not attend before a treatment has started, or people fall out of it before treatment has begun following assessment. That is because people are terrified of having to deal with the demons in their lives that have led them into this addiction in the first place. But I think the report is very clear on the challenges ahead, and it's a complex and very difficult problem.

Thank you. And finally, David Rowlands.

Diolch, Dirprwy Lywydd. Can I start by fully endorsing all the sentiments expressed so eloquently by Dai Lloyd earlier on? As a sitting magistrate for 13 years, I saw the devastating effect that drugs and alcohol can have on individuals' lives and, very often, those individuals came from chaotic backgrounds and really did not have the sort of start in life that most of us enjoyed. Therefore, as a magistrate, and with the other magistrates, we always sought to have interventions that were not criminalising these people, if possible. But we were frustrated by the fact that, if we gave something like drug rehabilitation orders, they would not come into effect for something like four months, by which time, of course, the people had probably committed further crimes during that period of time. So, I fully endorse everything that Dai Lloyd said earlier on.

I want to turn now, if I can—. I'm sure the Cabinet Secretary will know that Brynawel House in Llanharan is one of only two residential rehabilitation facilities in Wales, the other being Ty'n Rodyn in Bangor, both of which were talked about earlier by Mark Isherwood. Brynawel offers life-changing treatment for those struggling with alcohol dependency, even dealing with those with alcohol-related brain damage. Their unique treatment techniques have been recognised by many local authorities outside Wales, and yet it appears to be badly neglected by local authorities here in Wales, to the extent that there's a very real possibility that Brynawel may actually close.

In fact, Merthyr Tydfil local authority, for instance, has not referred one patient to Brynawel in the last five years. This is despite the fact that each council can access the £1 million ring-fenced by the Welsh Government for residential care treatment. One of my constituents told me that she had begged Merthyr council to admit her husband to residential care, but was told unequivocally that Merthyr borough council did not refer alcohol abusers for this type of treatment. This appears to be a stance that many local authorities are adopting given the lack of take-up of the facilities offered by Brynawel. Surely, with statistics showing that other interventions are having limited success, it is incumbent on local authorities to explore every type of intervention, including residential treatment. I call upon the Minister to explore the reasons for local authorities’ reluctance to use residential treatment as one of the tools to treat alcohol and drug abuse, particularly where other interventions have failed. 

Thank you very much. I call on the Cabinet Secretary for Health and Social Services to reply to the debate.

Thank you, Deputy Presiding Officer. I’d like to thank Members for a constructive and considered debate on tackling substance misuse. As was noted both in my opening remarks and by most Members who spoke, this is an ever-changing landscape, which makes our work very challenging. As Jenny Rathbone said, this is a complex and difficult problem, so there isn’t a simple answer that is glaringly obvious and staring us in the face. There’s something about understanding the nature of the challenge we face and the scale of it as well, and in my remarks I’ll try to respond to some of the points that each speaker made, but forgive me if I don’t get round to dealing with all of the points that every single person made.

I’ll start with Mark Isherwood and the point about inpatient services, tier 4 services, and in particular points about tier 4 services and detox as well. There was a particular view of history that Mark set out as to where we have been and where we are. On some of the comments made about the range of treatments at Brynawel—in particular David Rowlands mentioned that—I’m happy to say that Brynawel is not just for people in my colleague the Member for Ogmore’s constituency, but serves people in a wide area of places. The outlook for Brynawel has improved, and it has come about because there’s been real engagement between Brynawel and the Welsh Government, both in funding the alcohol-related brain damage pilot—there’s more to be done on that—but also in conversations not just around the framework for tier 4 services, but actually the practical relationship between commissioners and Brynawel as the service provider, understanding the range of services Brynawel can offer, and that commissioners can place there as well. I think there is, at last, a growing understanding of the services that are potentially available. As I say, on the inpatient detoxification front, I think there is more work to be done on understanding where is the most appropriate place for somebody to receive that service, because some people currently receive that service in a hospital setting, and that may not be the right place for them.

I’ll try to deal with the substantive points made by both Dai Lloyd and Leanne Wood, not just about the numbers of drug and alcohol-related deaths, but also the potential for some of the solutions. Actually, on some of this, we don’t disagree. The police and crime commissioners, for example, all unanimously agree that policing should be devolved, but it’s a matter of when, not if, from their point of view. We don’t fully share the view that Leanne Wood expressed. I’m not about to try and change Welsh Government policy on the future of devolution and all those areas of powers. But there is still something in our understanding of how we balance what we’re able to do and then to judge the value of that. I mentioned the role of naloxone and the fact that the kits have been used on more than 1,600 occasions. That, I think, does show that where that overdose has taken place and it has been deployed, you can honestly say that person was unlikely to have been there had that not happened.

So, there is something about understanding the effectiveness of what we are already doing, but also the scale of the challenge that we face. There’s a difficult debate for us to have, but an honest one to be had, to be taken seriously, as it is a really serious issue, about supervised injection or ingestion facilities. I think this is really difficult, largely because of the current law that exists in England and Wales. There is disagreement between police and crime commissioners, but chief constables themselves all have a real degree of caution about this in Wales. There’s something here about understanding the law and how it’s enforced, and to have a safe injecting area you’d need to actually have an agreement with the police about how they would and would not enforce the law, and that’s difficult. You’d be asking those police forces not to enforce the law around that area.

In particular, there's the challenge that then exists with the community as well—because all and any of us who have facilities in our constituency, whether they’re needle exchanges or other services, know that there’s almost always a large degree of suspicion. Also, people see the damage that drugs do, not just to individuals and their families, but to a wider community. And there's an understanding that wherever any treatment place is likely to be, you’re likely to have a community campaign, partly driven by fear, indifference, and frankly some of the less charitable elements of the human character, as well as people who are rather more concerned about whether that will become a magnet for the selling of drugs as well. So, there's an understanding about those parts, but also I'm genuinely concerned about the future of healthcare professionals, because if we ask them to supervise what is currently an unlawful activity, then I think there's a risk about their own future registration. I think there is a proper debate to be had and a review of evidence.

I hope it's helpful for those who are advocates of this as a solution that, for all of my concerns and caution about where we are now, the expert review group that advises the Welsh Government is looking at evidence, not just internationally, to build on heath board trips to the areas that Leanne Wood has mentioned, but also Denmark as well, and looking at the current evidence around what may or may not be happening in Durham, to give us further advice on the effectiveness of what is provided, but also what we can do here in Wales as well. As I say, this is a serious debate to be taken seriously, because potentially there is a way, if we can find it, to save even more lives. 

Dealing with some of the points John Griffiths raised about capital use and appropriate facilities, there's been real concern between myself and the then Minister for public health, as she then was, on the way in which capital is used, but also the return that we find on that and the security of the public investment we make in facilities, to make sure that they continue to be available for that purpose as well. We've had some concerns about the way that we haven't been properly protected in the past, but I think we're in a better place now to make sure that capital is wisely invested.

I recognise the points that both you and Jenny Rathbone made about parenting and role-model behaviour on a range of fronts. What is actually encouraging between the points yourself and Jenny Rathbone made is that, on alcohol at least, we are seeing lower rates of alcohol misuse by younger people. There is still a hardened element to that, but, overall, young people are more likely not to drink or not to drink to excess. I think there is something about the understanding of why we're taking forward minimum unit pricing, because that is part of our approach. But we should not pretend that that in itself resolves all ills, because it won't. There really is something about the education and the knowledge that we equip people with to make their choices, and that gives me some encouragement about the as yet unresolved issues around substance misuse in its broader sense, and in drug use, and in particular the points that Caroline Jones made about and cannabinoid use and new psychoactive substances.

There is a lack of knowledge and understanding about the dangers that those substances present to users and people around them, and it's for us to try and find a way through that to try and equip people to again make those wiser and more informed choices. Because that lies at the heart of our approach—how we equip people to make choices and how we maintain the harm-reduction approach that we have. I hope that Members will support the motion and either support the Government in its amendments or, in any event, support the final motion before us at the end of today's business.

Thank you very much. The proposal is to agree amendment 1. Does any Member object? [Objection.] Therefore, I defer voting under this item until voting time.

Voting deferred until voting time.