Residential rehabilitation: status report on current levels of capacity

3. Main findings

3.1 Current Capacity

Of the 20 residential rehabilitation facilities surveyed, all replied. Sixteen of facilities provided residential treatment for both alcohol and drug addiction, 3 provided treatment for drugs only and 1 provided treatment for alcohol only. Fifteen (75%) of services were voluntary or not-for-profit, 3 facilities (15%) were privately funded, and 2 facilities (10%) were funded by the NHS. A full list of all rehabilitation providers contributing to this analysis are provided in Appendix A.

Of these facilities, the total estimated number of beds available, for the treatment of alcohol and drug addiction, in Scotland is 418. This is 53 more than that previously reported^[2]. The estimated total number of residential beds available for the treatment of drug addiction is 406. Of the 418, around 297 placements were for both men and women (71%), around 104 were for men only (25%), and 17 were for women only (4%). Around 70 placements (17%) were specifically for young people.

As a result of the current COVID-19 pandemic, a number of the surveyed rehabilitation providers reported running at a reduced total capacity. The current combined capacity for residential treatment, was 386 beds/placements, at the time of survey. This is a reduction by just under 8%.

Residential rehabilitation providers reported that a combined total of 268 beds were currently occupied at the time of survey. This indicates thatresidential Rehabilitations are running at around 69% of their current capacity and around 64% of their total maximum capacity. This ranged from 50%-100% of current capacity.

3.2 Increasing Current Capacity

Residential rehabilitation providers were also asked to comment on how they may be able to increase their total capacity in the short-, medium-, and long term. Below is a thematic summary of what was mentioned.

3.2.1 Short term

In the short term (in the next week), residential rehabilitation providers primarily spoke of the need to secure additional resource to better cope with the impact of COVID-19 on their service. Providers mentioned that a combination of vaccination and regular testing in residential care would significantly reduce the impact of the pandemic. Specifically, this would free up beds currently set aside for self-isolation and open up more treatment places.

Other short term actions to increase overall capacity in existing services included specific minor refurbishments of vacant space within their service and the need to upgrade systems. Providers mentioned that this was dependent on securing funding for this work.

In addition, existing pathways to secure funding for placements was mentioned as a significant barrier to fulfilling current capacity. Providers found navigating ADP funding pathways difficult and took a long time, and would welcome a more simplified and centralised route to apply for funding. Specific mention was made of the success of the Prison to Rehab pathway. Some providers also mentioned that centralised block purchasing of places would likely also help improve planning within the service and make the admission process into rehabilitation more streamlined.

3.2.2 Medium term

In the medium term (in the next 6 months), in addition to the already mentioned short term actions, rehabilitation providers mentioned the need to secure funding for more significant renovation and or building work to make additional space for residents. In addition securing funding for the recruitment of additional staff would also increase capacity in the medium term.

There was also specific mention of the need to further develop the pathway from detox into rehabilitation. In situations where detox is a pre-requisite to rehabilitation admission, detox and admission into rehabilitation are not always fully joined up and often individuals need to return to the community in the interim period. Providers mentioned the need to further build relationships with detox providers and secure funding for external, often private, detox. This would achieve a more streamlined transition from detox into rehabilitation and ultimately would allow more individuals to enter rehabilitation.

3.2.3 Long term

In the long term (in the next 12 to 18 months), in addition to the already mentioned short and medium term actions, the principal action mentioned by rehabilitation providers was to be able to secure a new building and staffing resource.

Other actions included securing new community facilities such as supported accommodation to allow residents to safely move out of residential care and free up space for new residents.

It was also mentioned that by securing new facilities that specifically meet the needs of women and women who require childcare facilities, capacity for these groups would increase.