Residential Rehabilitation Working Group minutes: October 2020

Attendees and apologies

In Attendance

• David McCartney – Chair, Clinical Lead, LEAP
• April Adam – Service Manager, FIRST
• Hannah Cornish - NHS
• David Pentland – Change Team
• Jardine Simpson – CEO, SRC
• Steven Stark - Senior Social Worker, Integrated Alcohol Service Aberdeen
• Anniek Sluiman, Health and Social Care Analysis, SG
• Lyndsey Wilson-Hague – Head of Operations, Phoenix Futures Scotland
• Ruth Winkler – SG, Secretariat

Apologies

• Annemargaret Black – Chief Officer, Clackmannanshire & Stirling IJB
• Graeme Calendar – Alcohol and Drug National Support Team, SG
• Angela Morgan – Community Justice Interventions Unit, SG
• Justina Murray, CEO SFAD
• Vaughan Statham -  Programme Manager, National Prison Care Network NHS National Services Scotland
• Dr Zoe Stanley - Head of Substance Misuse Psychology, Forth Valley Substance Misuse Services
• Rosemary White - Lead Officer, North Ayrshire ADP
• Catriona Loudon – SG, Secretariat

Items and actions

1. Welcome & apologies

1.1. The Chair welcomed the group to the second meeting and introductions were made noting Hannah Cornish joined as substitute for Vaughan Statham.

Matters Arising
2. Minute & actions of previous meeting

2.1. The previous minute of 30 July was agreed as accurate and final.
2.2. Actions were reviews and the following updates were noted:
a)Para 3, sentence 1-3:  It was agreed that data on distribution of residential services across Scotland and which areas sent more or fewer people to residential rehab would be covered my item 3 on the agenda.
2.3. Jardine provided a brief overview of the separate Recovery and Residential (RR) Group for the benefit of members. It was noted progress had been made to recruit a prisoner and healthcare recovery worker.
2.4. The offer of support from the RR Group was re-iterated. This was welcomed and noted for further discussion later in the agenda.

3. Mapping of residential rehab provision in Scotland (Paper 12(10)01)

3.1. Anniek was welcomed and introduced paper 12(10)01 ‘Mapping of residential rehab provision in Scotland’ for discussion. Group feedback was noted as followed against each ask, as set out in the paper:

•  if these research questions accurately reflect their priority areas of research, and what (if anything) is missing;
  • the research questions were agreed as accurate.
• if priority can be assigned to any specific question(s) or topic(s);
  • mapping existing provision was agreed as the immediate priority.
• how best to capture new data (e.g. national survey of providers) and what data collection timeframe will be most useful to refer to for this exercise (e.g. last financial year);
  • it was agreed to forward to Jardine for him  to take to the RR Group to help fill in remaining data gaps where they are able. Action 1: Anniek / Jardine
  • it was noted ADPs report against total spend for residential rehabilitation provision in their local area.  It was agreed, while this would not provide a case by case breakdown of cost, it would provide a helpful starting point for understanding cost.
• if the working group can suggest any other sources of existing data that may assist in answering these questions
  • it was suggested a survey may be helpful to reaching out more widely and capturing any remaining data gaps.  It was noted that it would be helpful to provide an accompanying pro-forma to the mapping document to support consistency across data capture.
• what areas of research can the expert working group assist with in answering.
  • it was agreed to share Anniek’s presentation with Jardine in advance of his group’s meeting of 13 October with a view to that group making quick progress to help fill in gaps. Action 2: Anniek / Jardine

3.2.    The group agreed that gathering qualitative information would help develop the detail and context to support the recommendations that will be made by the group.
3.3.     Thought was given by the group to the main issues the recommendations may need to address.  The following were noted:

• equality of access to eliminate postcode lottery
• source of funding (noted that in Fife funding for Residential Rehab is routed via the council and not the ADP)
• need for a standard approach for commissioning; issues around funding and discrepancies of provision in local areas were noted
• how to get most ‘bang for buck’
• need clarity on what small localised community based resources exist and how they sit with ADP Residential Rehab services (Brighton Place and Safe as Houses were noted.  There was thought amongst the group that Brighton Place was closed, however Jardine noted Safe as Houses were members on his group and agreed to find out further information on that resource and feedback. Action 3: Jardine
• a definitive of providers across Scotland should be made available

3.4.    The discussion turned to pathways.  Potential opportunities to divert people from police custody to residential rehab was raised.  How best to support disadvantaged groups was further discussed with Armed Force veterans specifically noted.  It was highlighted that there is a policy custody sub-group to Jardine’s RR group and it was agreed to discuss more out-with the meeting. Action 4: Jardine / Hannah 
3.5.    In summary, the Chair noted the challenging timeframes to meet the Ministerial delivery ask of late November.  The group were asked to feedback further thoughts on immediate priority areas to Anniek, cc the wider group so further discussion could continue by email. Action 5: All / Secretariat

4. Scoping good practice: access and aftercare (Paper 12(10)02)

4.1.    The paper was outlined and views sought on the proposal to create a sub-group to scope good practice and report back to the main group.
4.2.    There was consensus across the group of the following points:
• challenges of identifying those suitable for residential rehab
• potential crossover with the RR Group Test of Change proposal to the Drug Deaths Taskforce about people identified at risk of overdose
• The Fife model will be a good model to consider as an example of continuum of care – it was further noted that was cited in the Dundee report (*) as an example of good practice. 
4.3.    Membership was agreed as David McCartney (Chair), David Pentland, Jardine Simpson, Lyndsey Wilson-Hague and April Adam.  Steven agreed to ask Simon Raynor to join as an ADP lead and confirm to secretariat. Action 6: Steven
4.4.    It was noted SG (Ruth) will lead secretariat support, including comms planning, and meeting will be arranged imminently.  The potential of a zoom seminar to share guidelines was discussed and SG agreed to link up with Jardine on arrangements Action 7: Secretariat 

5.    Examples of good practice

5.1.     The group discussed further examples and components of good practice.  Views expressed included the following points against key themes:

• continuum of care 
• minimum effective treatment time
  • available evidence suggests this is 3 months
  • treatment time offered now less than in the past
  • the time a treatment lasts can depend on each case and the time someone is able to be away from home
• existing evidence on improving outcomes:
  • involving families in the treatment 
  • incorporating education and treatment and training into treatment 
• value of a visible recovery community
  • how people may be best directed to the right place for support and if treatment is the right support for everyone?
• psycho-social support interventions
• the bridge from treatment to recovery communities
• LPASS and NHS Education training: safeguarding and ethical framework

6. Examples of provision in Scotland for mothers to take children into Residential Rehab

6.1. The group discussed provision for parents to take children into rehab with them in Scotland.  The following was highlighted: 
6.2. LEAP tailor programmes to allow for children to be looked after during the day and allow the parent most participation in the programme.  Phoenix refer to their Sheffield service.
6.3. Three services were thought to be available in the UK which work with the whole family: Good News, Derbyshire; Trevi House and Phoenix, Sheffield.  
6.4. The Family Support Service, run by Aberlour Childcare Trust, was noted as having offered this in the past with good outcomes, but had closed. The group understood this may have been due to funding - which was noted as having complications around which services fund each part of these models of services.  Joyce Barlow was suggested as a contact for further information.
6.5. The group agreed a national funding system and commissioning model through NHS Scotland Chief Executives would be required for any such model in Scotland.
6.6. Hannah offered to provide further information around the English commissioning model if needed for more consideration. 

7. Reporting schedule

7.1. The timetable was noted as challenging.

8. AOB and next date of meeting

8.1. The next meeting was agreed as 17 November for secretariat to confirm in diaries following the meeting. Action 8: Secretariat
8.2. David asked if it was ok to share the papers and details of meeting with the Change Team. Secretariat agreed to confirm following the meeting. Action 9: Secretariat (note: now agreed and cleared)
8.3.No further items were raised. The group was thanked for their participation and the meeting closed.

(*) - 

https://www.dundeecity.gov.uk/sites/default/files/publications/part1reportfinal.pdf

https://www.dundeecity.gov.uk/sites/default/files/publications/supportingpart2.pdf

https://www.dundeecity.gov.uk/sites/default/files/publications/supportingpart3.pdf

https://www.dundeecity.gov.uk/sites/default/files/publications/dp_action_plan.pdf

https://www.dundeecity.gov.uk/sites/default/files/publications/20191023_dpforumreport.pdf