Drug and alcohol residential treatment services recommendations: SG response

Accept: We agree with the principle that there should be access to residential treatment on an equitable basis across Scotland.

This recommendation links to recommendation 5a. We will consult partners and stakeholders on equality of access and discrepancies of provision in local areas.

We will review known and emerging issues around equality of access through established ADP engagement and monitoring routes.

Ongoing: We are working to ensure that residential rehabilitation is available to everyone who wants it – and for whom it is deemed to be clinically appropriate – at the time they ask for it, in every region of the country.

The initial mapping analysis has been completed and provides a firm basis to consider issues around local provision.

A significant proportion of the extra funding for allocation over the next session of Parliament will go towards developing sustainable capacity in regional centres across the country, and this work will be inclusive of different models of care.

Accept: Scottish Government will monitor ADP supported access to for residential rehab through the Drug and Alcohol Information System (DAISy).

• DAISy is a national database which will gather key demographic and outcome data on people who engage in alcohol/drug treatment services. It will improve the understanding of the impact of alcohol/drug treatment services at both a local and national level. The project has been led by Public Health Scotland.

Ongoing: This is in line with existing national requirements on treatment provision and can be monitored through DAISy. DAISy went live on 1 December 2020 and all ADPs will have implemented DAISy by 1 April 2021.

Accept: We will work with national organisations in Scotland to ensure that existing treatment service directories include information on residential rehabilitation services provided by the private, public and third sector.

Planned: The recent mapping work and capacity analysis will be shared with ADPs to help them with the referral process.

Going forward we will ensure that treatment services are included in existing national directories in 2021. This will include information on performance against existing standards and requirements set by the Care Inspectorate and Healthcare Improvement Scotland.

Accept: This recommendation is linked to recommendation 9a.

Ongoing: DAISy will capture information on residential treatment episodes.

As noted DAISy went live on 1 December 2020 and all ADPs will have implemented DAISy by 1 April 2021.

Accept: This recommendation links to recommendation 5a. We will consult partners and stakeholders on local barriers to accessing treatment as part of work to develop the good practice guide.

Ongoing: We propose to undertake further analytical work in early 2021 to map the pathways into and following on from residential rehab to identify barriers and enablers. This will inform the development of Good Practice Guide on Pathways into and from Residential Treatment. See 5a.

Accept: The report estimates that about 830 people who were resident in Scotland prior to their placement, accessed residential treatment in 2019-20. In addition the report exposed wide variation in referral rates by different ADPs which could not be fully explained by their population size or estimated need. It also identified variation within residential treatment providers themselves in terms of staffing complement, roles, programme duration and waiting times.

As a result we will work with local areas collectively to produce needs assessment which establish the level of residential rehabilitation services required alongside and integrated into community services .

We will link this work to recommendations 3a and 7a to ensure that residential treatment models and approaches to funding these services are included in our work to better understand need.

Planned: The further analytical work around understanding pathways into rehab will provide more detail on regional variation and will help under pin regional needs assessment.We will work with local areas collectively to deliver a needs assessment to inform local delivery arrangements.

Accept: This is linked to recommendation 1b. Scottish Government and Public Health Scotland have developed DAISy to measure current capacity accurately, understand and monitor waiting times, anticipate demand and monitor bed usage. This will help us to maximise efficiency.

Ongoing: See 1b.

Accept: We accept that costs of services and funding models must support equity of access to services at the time they are needed.

We accept that funding models can play a significant role in determining the availability of rehab within a local area and across Scotland.

We will link the work to map these models to recommendation 2a. This will ensure that this work is included in our overall approach to undertaking needs assessment. This will enable us to draw conclusions on the level and type of residential rehabilitation services that are required alongside the funding models needed to secure their delivery.

Immediate. See recommendation 2a.

Accept: The group highlight that the cost of rehabilitation treatment varies substantially depending on the nature of the programmes offered, the staffing mix and the funding model of the facility with data suggesting an average minimum cost per treatment place in Scotland in 2019-20 around £17,800. Understanding value for money from residential rehabilitation requires consideration of initial costs offset against reductions in subsequent healthcare and criminal justice costs. Further research into the health and social economics of the intervention will be undertaken to inform decision making.

Planned: We will monitor costs and variations as part of a monitoring and evaluation framework for the new investment.

Accept: This recommendation links to recommendation 5a. Work is already underway to produce a draft Good Practice Guide on Pathways into and from Residential Treatment through a subgroup of the Scottish Government Residential Rehabilitation Working Group. We will develop the detail of the guidance through public consultation and further stakeholder engagement and use this for the basis for identifying standards for commissioning residential placements.

Planned: We will explore this with the Care Inspectorate and Healthcare Improvement Scotland following, and subject to, the development of Good Practice Guide on Pathways into and from Residential Treatment.

Accept: The group point to a high level of consensus from existing guidance that residential rehabilitation treatment is best suited to those with higher problem severity. While decisions on the most appropriate treatment for alcohol/drug use are for clinicians and practitioners to make in partnership with their patient/client and their families, we agree that no one, particularly the most vulnerable, should be arbitrarily excluded from residential treatment due to complex needs or higher problem severity.

Ongoing: As detailed in section 1e above we are committed to further research to understand existing referral pathways.

Work is already underway through the Residential Rehabilitation Working Group to explore current examples of good practice and develop a Good Practice Guide on Pathways into and from Residential Treatment. This includes giving specific consideration on pathways for vulnerable and under- represented groups. The detail of the guide will be developed through consultation and engagement including with people with lived / living experience and their families to ensure pathways meet their needs.

We will further develop and trial the guide with ADPs ahead of giving consideration to developing this into a set of standards (see recommendation 4a).

Accept: Scottish Government will engage with the Drugs, Justice and the Law Subgroup of the Drug Deaths Taskforce who will lead work to explore options.

Planned: Scottish Government will explore and facilitate opportunities for closer working with this group on the role of residential services at the beginning of 2021.

Accept: Scottish Government will engage with Drug Research Network Scotland and the Scottish Alcohol Research Network to explore opportunities to commission research into residential treatment pathways, models, outcomes, value for money and service user experience to understand who will benefit most from it.

Planned: Scottish Government will explore opportunities for research with these organisations in early 2021. (as detailed in section 1e above)

Accept: Scottish Government will engage with the Drug Research Network Scotland and Scottish Alcohol Research Network to develop a scope for this work.

Planned: Scottish Government will explore opportunities for research with these organisations in early 2021.

Accept: We will engage with the Drug Research Network Scotland to develop a scope for this work.

Planned: Scottish Government will explore and facilitate opportunities for further research on residential rehabilitation with these organisations in early 2021.

Accept: this will be developed as part of Recommendation 2a.

Planned: See 2a.

Accept: This recommendation links to recommendation 5a. We will liaise with the Drugs Death Taskforce secretariat to explore opportunities for engagement with the Drugs Death Task Force Multiple Needs Subgroup.

Planned: Scottish Government will explore opportunities for the development of a relationship at the beginning of 2021.

Accept: As part of our investment of £20 million per annum over the next session of Parliament for residential rehabilitation and associated aftercare we will test and develop new approaches as required. We will use the forthcoming Good Practice Guide on Pathways into and from residential treatment to inform the development of tests of change.

Ongoing: We have already invested £150,000 in testing the Prisons to Residential Rehabilitation Pathway to allow people leaving prison to access residential treatment to continue their recovery journey.

The Continuum of Recovery for Near-Fatal Overdose (CORNFO) project has been awarded £288,088 over 2 years by the Drug Deaths Taskforce. Facilitated by the Scottish Recovery Consortium and hosted by South Lanarkshire ADP, this pathway is targeted directly towards those people most at risk from drug related death who have experienced a near-fatal overdose. It combines an urgent community-based response with direct access to residential rehabilitation treatment. The CORNFO test of change will begin in January 2021 and is expect to be completed January 2023. It will be evaluated during the project to inform how we proceed.

We will continue to assess where TOC are appropriate and invest on an ongoing basis.

Accept: The work of the group point towards a gap of evidence on longer term outcome evaluation. One of the benefits of Scottish Government's introduction of DAISy will be to allow for conformity on outcome measurements and a central way of gathering and analysing data. This will allow us to broaden learning and evidence around residential rehabilitation on an ongoing basis.

We will work with partners to ensure that the DAISy dataset remains fit for purpose to measure key outcomes for people accessing residential treatment. This includes their outcomes on leaving residential treatment as well as throughout their treatment journey.

Planned: Scottish Government will work with partners to ensure that the DAISy dataset remains fit for purpose to measure outcomes for this who access residential treatment ADP.

Accept: This recommendation is linked to recommendation 9a.

Planned: This will be delivered in line with the implementation of DAISy.