Alcohol – the missing component of the new science curriculum

On the day that the new national curriculum is unveiled we see that according to surveys undertaken by the School Health Education Unit one in ten primary school leavers say they have drunk alcohol in the last week.

As we know the Department of Education’s standard line on these things is to point to the science curriculum and then say that this can be built on through PSHE education.

So it is worth looking at whether in this final version of the curriculum the DfE have made any changes to the way they describe what schools need to teach when it comes to smoking, drugs and alcohol.

Assiduous readers of this blog will recall we looked at the proposed curriculum back in February and will therefore be prepared for the scant attention that is paid to drug education as a part of the science curriculum.

  • There is no reference to alcohol (except as part of organic chemistry in Key Stage 4).
  • In Year 6 pupils “should learn how to keep their bodies healthy and how their bodies might be damaged – including how some drugs and other substances can be harmful to the human body.”  And might look at the scientific research about the relationship between drugs and health.
  • In Key Stage 3 the biology curriculum includes teaching “the effects of ‘recreational’ drugs (including substance misuse) on behaviour, health and life processes.” What ‘recreational’ means isn’t defined.
  • Also in Key Stage 3 there’s an expectation that science teachers will touch on the impact of smoking on the “gas exchange system”.
  • Other than a mention for alcohol as part of organic chemistry there is no guidance for schools about teaching young people about drugs, alcohol, or tobacco between the ages of 14 and 16.

Overall this is, I think, the lightest of light touches and the failure to address alcohol specifically is worrying. I also can’t see how it will be credible for the next Focal Point report to say (as the last one did) that:

School-based drug education forms a central part of the United Kingdom’s approach to universal drug prevention.

What is clear to me is that without support from a fully developed PSHE curriculum it will be hard for schools to show how they are delivering a curriculum that meets the needs of their pupils when it comes to drug and alcohol education.

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Norman Fowler calls for Prevention Strategy

FowlerAs part of a wider set of interviews carried out to reflect on the 65th anniversary of the NHS Sir Norman Fowler makes some points that may resonate with readers of this blog.

He says:

far, far too little time and money is devoted to preventing ill health. It is still simply not taken remotely seriously enough. Much of my experience is with HIV at the moment and with the recent select committee we did point out that the Government was spending £760 million a year on drugs to treat people with HIV. I’ve got no complaint about that, but they spent £2.9 million a year on government publicity to prevent HIV. Actually they’ve now reduced even that. It does show something of the kind of priorities that we have.

And I think that prevention needs to be given priority. I mean it’s all very well having a separate budget, and I’m all in favour of that, but what it really needs is to be given a lead, a strategy, a belief, because without that people are still not going to take it very seriously.

And that goes way beyond HIV. It goes to all the things that people talk about – sugar, obesity, smoking, alcohol. You are going to be shot at if you go into that area. People are going to talk about the nanny state and all that. But that just has to be taken on. If you do these things one by one, it is highly dubious whether you really have an impact. I’d be all in favour of a separate prevention budget. But what it really needs is a strategy and a belief and someone with that belief to push it forward.

Responsiblity for Young People in Drug and Alcohol Policy

NO CHAOSChildren & Young People Now report the end of the Department for Education’s policy responsibility for youth policy.  This is a move that has been coming down the pipeline for some time, but I’m not sure that it’s as welcome as some other parts of the sector are saying in their comments to CYPN.

From our perspective it means that the vital policy link between a variety of risky behaviours, including substance misuse, is now no longer held in a single team but is spread across departments and will now be hindered (when it comes to substance misuse) by focusing on drugs, alcohol and tobacco in isolation.

Only last year the National Audit Office was praising the drug strategy as an example of joined up working across departments, saying:

Several joint strategies relate to early action. For example, the Home Office leads on the overall Drugs Strategy, and within this the Department of Health and the Department for Education lead jointly on reducing demand, including preventative measures.

Well that’s less true today than it was then.

The information we have is that the Home Office will now lead on the work the DfE would have previously done on young people and substance misuse. Although even that isn’t entirely sure as there is likely to be a substantial role for Public Health England and the Department of Health may still have some sway.  Meanwhile it is clear that other parts of youth policy – positive activities, youth voice etc. – are now to be addressed to the Cabinet Office.

The areas the DfE are reserving to itself are any education aspects, so things like behaviour and attendance, safeguarding and alternative provision will continue to be a DfE policy responsibility. The DfE will also continue to have responsibility for drug and alcohol education issues – though if the PSHE review is anything to go by we shouldn’t expect too much from that quarter at the moment.

PQ: Spending on drug and alcohol issues by NHS & local authorities

The Labour MP, Seema Malhotra, asked the Department of Health about the spending on drug and alcohol prevention and treatment.

The reply suggests that currently this data isn’t available (though we know that local authorities do already report their spending on young people’s substance misuse services), but that this may change.

Anna Soubry, the Public Health Minister, says:

Each local authority is free to determine their actual spend on alcohol and drug prevention, treatment and recovery based on an assessment of need. They will be required to report their spending in these areas on an annual basis.

What isn’t clear from the answer is whether the DH expect this to be broken down so that it is clearer how much (or little) is spent on prevention, treatment and recovery.

Given the importance that many government policies place on preventative work and in the context of how the last Focal Point report found it impossible to identify prevention spending at a local level it seems to that it would be important that this distinction is made.

How long before the government’s prevention fig leaves get blown away?

Fig leavesMentor has been quoted as part of a short debate on the Home Affairs Select Committee’s report on the government’s drug strategy.

Diana Johnson MP a Labour Party Home Affairs spokesperson, says:

Figures from Mentor, the drug and alcohol charity, show that at present 60% of schools deliver drug and alcohol education once a year or less. That education is often poor, incomplete or totally irrelevant; pupils aged 16 seem to get the same lessons as pupils aged 11. An example given was of sixth-form students being required to colour in pictures of ecstasy tablets as part of their drugs education. Earlier this year, Mentor told me:

“Drug and alcohol education should not be disregarded as a trivial add-on. It should be fundamental to pupils’ education. The links between early drug and alcohol use and both short and long term harms are clear, and there is compelling evidence showing longer term public health impacts of evidence based programmes. The cost benefit ratios are significant, ranging from 1:8 to 1:12.”

In terms of the wider debate there was a welcome focus on the role that prevention can play in reducing demand for drugs, but it is disappointing that all the Minister, Jeremy Browne, has to fall back on as concrete achievements of the drug strategy are the fig leaves of FRANK and the Choices Programme.

The evidence suggests that the FRANK website is unlikely to change behaviour on its own.  It may be that the helpline and other interactive services contribute to some preventative outcomes, but the Home Office have not (under successive government) undertaken or published any research on the behavioural impact of FRANK. Readers of this site will know that the EMCDDA recently recommended any mass media campaigns aimed at preventing drug use are accompanied by a robust evaluation. It is also worth noting that the budget for the services was been slashed to £500,000 last year suggesting that Ministers and officials don’t believe that it is an efficient way of spending money.

Mentor’s collaboration with Addaction on the Street Talk project was the largest single beneficiary of the Choices programme, so while we can be clear what we were able to achieve with the funding we also know that this was a one-off fund which allowed us to deliver the project for less than six months.  There has not been any suggestion from the Home Office that they will be continuing the programme.

It is also disappointing to see the Minister’s response on school based prevention, where he takes the line that good health education is somehow divorced from other educational entitlements.  Again readers of this site probably don’t need reminding of how interlinked risky behaviours and educational outcomes are.

If you are interested in reading the whole debate it can be found here.

PQ: Students, Ritalin and Modafinil

Conservative MP, Graham Brady, asks the Department of Health about what assessment the department has made on the misuse of Ritalin and Modafinil as cognitive enhancers, what they’re doing to restrict access, and inform students of the potential side effects.

The Minister answering, Norman Lamb, is on pretty solid ground when talking about the controls around the sale of these drugs – Ritalin is a Class B drug under the Misuse of Drugs Regulations, while Modafinil requires a prescription but isn’t controlled under the 1971 Misuse of Drugs Act.

He points out the restrictions around advertising Modafinil which apply to UK-based pharmacies, but admits these regulations don’t apply outside the UK, and goes on to say that the Medicines and Healthcare products Regulatory Agency (MHRA) have serious concerns about internet sales.

Lamb argues that there are regular warnings issued by the MHRA about buying medicinal drugs over the internet, and a quick look on the MHRA website turned up the a page on buying drugs off the internet and video which was uploaded to YouTube in December last year, since when it’s had 760 or so views.

The video, as you’ll see, takes a very traditional cautionary approach with a fictionalised account of a young adult needing emergency treatment because of his misuse of drugs bought from the internet.  At the end it advises viewers to visit www.RealDanger.co.uk which redirects to a Pfizer branded website, where interestingly there is a link to the same video, but this time on the Pfizer YouTube channel where it has had over 34,000 views.

The Pfizer site also links to a press release about a survey of pharmacists that suggests they think that internet sales of prescription drugs is rising, but doesn’t – as far as I can see – back this up with any data about the prevalence of misuse of medicines, or the number of hospital visits as a result of this.  They do however say that over the last 5 years the MHRA seized more than £34 million worth of medicine supplied illegally.

Of course what isn’t clear is how much of the seized medicines were the ones that caused Mr Brady to ask his question, nor on the prevalence of the misuse of these drugs, or whether the approach that Pfizer and the MHRA are taking is being successful in preventing further misuse.

Returning to the Minister’s response to the question, Mr Lamb, also comments on the role the national curriculum plays in informing younger students about drugs.  He rightly points out that the science curriculum has some broad words about teaching ‘the effects of drugs on behaviour, health and life processes’ and that this can be extended by PSHE teaching.

The prevalence of the misuse of medicines by school age pupils isn’t really measured by the Smoking, Drinking and Drug use survey.  They are able to show that 0.4% of pupils between 11 and 15 years said they took a Tranquilizer in the last year, as you’d expect they found that the proportions saying they’d used went up by age.

chart_1

I will need to check with Liz Fuller and her colleagues at NatCen that do the survey every year to check whether they ask about other medicines like Ritalin or other cognitive enhancers but certainly if they do the proportion is so small that they get gathered up in the ‘other’ category.

Talk to the hand, cause the face ain’t listening

If the evidence for youth focused mass media anti-drug adverts isn’t great what about focusing on parents?

I can’t say that I know whether there’s any more evidence for this approach, but it is certainly a tactic that those with budgets in this area have and are trying.

Today I came across the ‘Talk, they Hear You’ campaign that the Substance Abuse and Mental Health Services Administration in the US have put together to try to persuade parents that their influence on the risks their children take with alcohol can start earlier and go on longer than they might imagine.

As you can see the message is quite positive, and will be reinforced with online tools for practising the ‘awkward’ conversations and tricky issues that might be thrown up by an issue like alcohol.

It reminded me of the Why Let Drink Decide approach that briefly ran at the end of the last government where the message was a little darker, with pre-teens reminding us just how soon their innocence could be lost.

Can mass media campaigns prevent young people from using drugs?

The EMCDDA have reviewed the evidence for media campaigns aimed at preventing drug use by young people.  They note that one in three affiliated countries say they either don’t run these campaigns or have significantly reduced funding to them.

FRANK meowWe know that this includes the UK government which has cut spending on advertising the FRANK service year on year.  I think it is clear that the content of the last set of adverts that FRANK weren’t trying to effect young people’s behaviour, rather the aim was to drive traffic to the website, helpline and other services provided by the government.  Whether that’ll be true of the next set we’ll wait to see – I’m told there will be a focus on novel psychoactive substances over the summer period.

We have recently looked at other youth focused public health campaigns that Public Health England have inherited which aim to increase the positive conversations about health between peers and between parents and their children.

 

The conclusion the EMCDDA draw suggests that governments may be correct in being cautious in supporting this form of preventative action over other interventions given the current evidence.

They say:

The pooled analysis of studies found that media campaigns had no effect on reduction of use and a weak effect on intention to use illicit substances. Reports of possible unwanted effects in terms of young people declaring that after having watched a media campaign they were willing to try drugs raises concern. This is particularly relevant for prevention interventions, which are provided without a demand from the target population. Campaigns might affect individuals differently, depending on their level of awareness. However, being informed might not have a direct effect on behavioural change, while perception of norms (the perception that everybody is using drugs) may have an impact.

As a result they recommend that if campaigns are run they are only done so “in the context of rigorous, well-designed and well-powered evaluation studies.”

Reviewing a school drug policy and responding to substance misuse

This was a presentation that my colleague Claire James gave to a conference about safeguarding in school recently.

The recently reviewed guidance to school governors points out:

Section 175 of the Education Act 2002 places a duty on the governing bodies of maintained schools, and regulations under section 157, about safeguarding pupils in Independent Schools (which include academies) requires academy trusts to have arrangements in place to ensure that they:

  • carry out their functions with a view to safeguarding and promoting the welfare of children; and
  • have regard to the statutory guidance issued by the Secretary of State in considering what arrangements they need to make for the purpose of that section.

The governors document points to older guidance which defines safeguarding and promoting the wellbeing of children as:

  • protecting children from maltreatment;
  • preventing impairment of children’s health or development;
  • ensuring that children are growing up in circumstances consistent with the provision of safe and effective care; and
  • undertaking that role so as to enable those children to have optimum life chances and to enter adulthood successfully.

I think it would be difficult not to see drug prevention as part of the mix for supporting safeguarding; but it also makes me think about the needs of those pupils living with parents that are having problems with drugs and alcohol, or those children who are in care or being looked after by a family member (often because of drug and alcohol misuse) and ensuring that their needs are met.

DfE guidance for school governors and how to use it to make a case for drug prevention

The DfE have recently refreshed their guidance for school governors.  While there is no explicit reference to drugs or alcohol (unlike sex and relationships education which is addressed) there are elements in the guidance that may be useful.

Education

The guidance points out that (for maintained schools) the law demands that the curriculum should be “balanced and broadly based” and should

promote the spiritual, moral, cultural, mental and physical development of pupils at the school and of society; and prepare pupils at the school for the opportunities, responsibilities and experiences of later life.

One can, I think, make a very strong case that a school without a PSHE curriculum, including drug and alcohol education, would be falling down in regard to these duties.

Promoting the general wellbeing of pupils

Governors are advised that they have a duty towards promoting the wellbeing of their pupils which is set out in law as:

  • physical and mental health and emotional wellbeing;
  • protection from harm and neglect;
  • education, training and recreation;
  • the contribution children make to society; and
  • social and economic wellbeing.

Drug and alcohol prevention are ways that school governors can show they are contributing to the protection of pupils from harm as well as developing social wellbeing.

The guidance reminds governors of their duty to ensure the school has a behaviour policy based on regularly reviewed principles which must be the subject of consultation if they are to be changed.  Governors also have a number of roles in relation to exclusion including:

a wider role to hold headteachers to account for the lawful use of exclusion. Exclusion must be for disciplinary reason and all exclusions must be done in line with the legal requirements. Where a pupil is removed from the school premises without being excluded there needs to be a lawful basis for this decision, for example, under the powers of a maintained school to direct a pupil offsite to improve their behaviour.

Supporting pupils in school with additional health needs

The DfE recognise that some pupils will have additional health needs, which may include the need for medicines.  They say that governors should ensure that there is a policy for this eventuality and that:

The policy should address emergency procedures, training, supervision, record-keeping, including storage and disposal. It should also set up a named staff member to coordinate health care needs and to link with parents.

This reminds me of earlier guidance that DrugScope produced about handling Ritalin, a drug that seems to be of increasing concern in terms of misuse, which may be useful to schools.

Below is a presentation we’ve done aimed at helping school governors see how addressing drugs and alcohol could be important to their school.