Residential Rehabilitation Working Group minutes: November 2020

Attendees and apologies

Attendees

• David McCartney – Chair, Clinical Lead, LEAP
• April Adam – Service Manager, FIRST
• Annemargaret Black – Chief Officer, Clackmannanshire & Stirling IJB
• Justina Murray, CEO SFAD
• David Pentland – Change Team
• Jardine Simpson – CEO, SRC
• Nick Smith - SG
• Dr Zoe Stanley - Head of Substance Misuse Psychology, Forth Valley Substance Misuse Services
• Anniek Sluiman, Health and Social Care Analysis, SG
• Lyndsey Wilson-Hague – Head of Operations, Phoenix Futures Scotland
• Ruth Winkler – SG, Secretariat
• Catriona Loudon – SG, Secretariat
• David Baruffati – SG, Researcher
• Maggie Page – SG, Principal Researcher

Apologies

• Graeme Calendar – Alcohol and Drug National Support Team, SG
• Angela Morgan – Community Justice Interventions Unit, SG
• Vaughan Statham -  Programme Manager, National Prison Care Network, NHS National Services Scotland
• Steven Stark - Senior Social Worker, Integrated Alcohol Service Aberdeen
• Rosemary White - Lead Officer, North Ayrshire ADP

Items and actions

1. Introductions, Welcome & Apologies

1.1. The Chair welcomed the group and introductions were made, noting David and Maggie’s attendance to speak to item 3 on the agenda.  Nick Smith was also noted as in attendance to help answer any questions on next steps and outstanding work.
1.2. Apologies were noted from Angela Morgan, Rosemary White, and Graeme Callander. 

2. Minute & Actions of Previous Meeting

2.1. The minute from the last meeting was agreed as accurate and final.  Outstanding actions were reviewed and noted as complete, with the one remaining action noted as on track.

Matters Arising
3. Mapping Exercise: Summary 

3.1. David Baruffati and Maggie Page presented a summary of the mapping summary report paper. Discussion followed, findings were broadly agreed as being in line with expectations, however the number of beds was noted as higher than expected and the quality of services reported was welcomed.  The following further points were noted:

• it is difficult to define what is and isn’t a residential rehab service / bed.  Further work is needed in longer time to give clarity to the number of beds available
• fife is considered an area of good practice which will be useful for the sub group on good practice to look at
• whether rehab services are open to everyone across Scotland or just those in specific areas will impact bed capacity
• further work will be needed to reach non-responders

3.2. The Chair welcomed Annemargaret Black’s offer to help contact IJB Chief Officers where survey data may be missing.  It was agreed timings would not allow the work to take place to meet the immediate Ministerial reporting deadline but there is scope for future work to take place, as part of the recommendations, for more comprehensive information to be collated to clarify unknowns.
3.3. The Chair requested the group send any comments on the mapping summary report paper this week. Action 1: All

4. Review Draft Recommendations

4.1. The Chair gave an update of wider stakeholder engagement he had done with Scottish Drugs Forum (SDF), Tracy Clusker and Favor UK.  
4.2. These stakeholders unanimously identified the importance of addressing equity of access to residential treatment and independently expressed a range of other views including: consideration of central funding for rehab, having rehab integrated into every treatment system and free at the point of delivery, adopting the PHE guidelines on mutual aid referral; research being directed into rehab and recovery; considering rehab for people on medication assisted treatment, having a system to measure capacity and demand; fears that nothing will change; rebalancing of resource allocation to increase rehab capacity and having a national rehab coordinator. One stakeholder detailed a case series of same day opiate replacement start patients, almost half of whom went on to residential treatment and are still retained in treatment, encouraging us to raise the bar in terms of what’s possible. Another recommended rehab as a holistic intervention for poly-substance dependent clients/patients.
4.3. The Chair also noted he planned to update Catriona Mathieson, Chair of the Drug Deaths Taskforce (DDTF) on the work of the group.  Potential opportunities around DDTF TOC funding was raised as a point to discuss for further information.   David McC also undertook to speak with Derek Feeley, tasked with chairing the independent adult social care review, and SHAAP following suggestions by the group. Action 2: Chair
4.4. Funding awarded to residential rehab TOC projects by the DDTF under their Innovation Fund was raised.  SRC’s award  for a project addressing wrap around care and the continuum of recovery was noted.
4.5. The draft report and recommendations was summarised by the Chair, recognising short notice for the group to have reviewed in detail.  Comments were invited by email to secretariat by noon Friday for collation and the chair to consider and inform a further draft.  Feedback was asked to focus on three aspects:

• if the report is authentic to the discussions of the group
• any corrections
• any obvious omissions
• order of recommendations to aid emphasis

Action 3: All
4.6. Immediate thoughts were feedback as follows:

• further work to agree how to define, identify and record resi rehab will help inform understand of bed capacity and how this has changed over recent years
• Castle Craig treatment services account for around 25% of beds
• further work needed to confirm where service users come from: if all beds are open to people across Scotland, local area only or, used by health insurance providers from abroad

4.7. The general consensus between the group on main findings and also between the work of this group, the SRC led Recovery and Residential Group and wider Chair’s engagement with SDF, Tracy Clusker and  Favor UK was noted and welcomed.  It was agreed to add details of the wider engagement to the report. Action 4: Chair
4.8. Recommendation 7 was discussed. It was agreed to feedback comments to expand on detail of what treatment should look like, with particular mention of what is meant by medical approaches and how to measure treatments. Action 5: Dr Zoe Stanley
4.9. It was noted areas of good practice may be better suited to the work of the sub group but this would be considered when receiving feedback and shared, as necessary so points were captured.

5. Next Steps

5.1. It was noted that the work of the group had uncovered some unknowns and areas requiring further research.  Timing constraints to look into these further in time to report was noted.  It was recognised recommendations would make reference to where further work was required and there may be an ask for the group to continue with a revised membership and remit to support this work.
5.2. Timings for presenting the paper to Ministers and publishing were set out by Scottish Government.

• comments on the paper to be sent to Secretariat, cc the group, by Friday noon
• comms planning being undertaken by SG this week; announcement likely to be high level to welcome the report
• announcement by the Minister to welcome the report planned 30 November.

6. AOCB

6.1. They group agreed they were content for minutes to be published on the Scottish Government website.

7. Close

7.1.The Chair thanked the group for giving their time to the work, particularly given the challenging timeframe.  The Chair also thanked David B, Maggie and Anniek for their research work, noting the depth and quality of information they had been able to produce in a short time.
7.2.The meeting was closed.