Residential Rehabilitation Services: recommendations on clinical governance

Recommendations

Regulation and Governance

• RR providers receiving public funds should join the National Flexible Framework and purchasers (HSCP, ADPs) should purchase exclusively via the framework.
• Placements funded in whole or in part by the Scottish Government (Additional Placement Fund, Core Funding or Prison to Rehab) must be done via the National Flexible Framework.
• Take steps to mandate HIS oversight of all clinical activity in residential alcohol and drug treatment settings (excluding NHS settings), including detoxification and stabilisation. However, it is recognised that the burden on rehabilitation services should not be unduly increased.
• Ensure inspections involve clinicians with expertise in RR and detoxification.
• Implement continuous quality improvement systems in all RR services.
• Government should explore the issue of detox when it is provided directly from primary care within residential rehabilitation setting, given the current lack of oversight or governance.

Clinical Guidance

• Develop RR-specific clinical guidance covering assessment, triage, detox planning, prescribing, monitoring, relapse prevention, harm reduction, and mental and physical health support.

Detoxification and Pathways

• Expand detox capacity and reduce delays in admission.
• Establish clear pathways linking community treatment, detoxification, and RR services.

Stabilisation Services

• Commission stabilisation services to ensure access to a broader range of support, including residential rehabilitation, aligned with individual needs and preferences. Ensure robust evaluation and research to build an evidence base for stabilisation models.
• Include clear, referral pathways to further support - such as residential or community-based rehabilitation programs - where clinically appropriate and aligned with a person’s goals and consent.

Data and Reporting

• Extend the RR National Dataset to capture detoxification and stabilisation data, including planning, completion rates, and relapse prevention measures.
• Ensure secure storage and appropriate sharing of clinical data.

Workforce Development

• Define roles and competencies for staff delivering clinical services in RR settings.
• Require training for all staff involved in detox care, with advanced training for prescribers and other clinicians.
• Develop a training programme to ensure training needs are accessible and met.

Harm Reduction

• Require all RR providers to implement comprehensive harm-reduction and overdose-prevention approaches, including, but not limited to, naloxone provision and training, overdose risk education, BBV screening and treatment, relapse-prevention medication and assertive linkage to community and mutual-aid support.
• Establish clear, consistent protocols for all instances of discharge or leaving services, including premature discharge, to reduce risk and ensure planned transitions, continuity of care, and follow-up support.