- 2 Dec 2020
Attendees and apologies
- David McCartney – Chair, Clinical Lead, LEAP
- April Adam – Service Manager, FIRST
- Annemargaret Black – Chief Officer, Clackmannanshire & Stirling IJB
- Angela Morgan – Scottish Government, Community Justice
- Scott Clements – Head of Programmes, SFAD
- David Pentland – Change Team
- Jardine Simpson – CEO, SRC
- Dr Zoe Stanley - Head of Substance Misuse Psychology, Forth Valley Substance Misuse Services
- Steven Stark - Senior Social Worker, Integrated Alcohol Service Aberdeen
- Vaughan Statham - Programme Manager, National Prison Care Network NHS National Services Scotland
- Rosemary White - Lead Officer, North Ayrshire ADP
- Lyndsey Wilson-Hague – Head of Operations, Phoenix Futures Scotland
- Ruth Winkler – SG, Secretariat
- Catriona Loudon – SG, Secretariat
Items and actions
1. Welcome and Introductions
1.1. The Chair opened the meeting with welcoming the members and introductions. Conflicts of interests were discussed, and the Chair noted his own conflict of interest due to working for a Residential Rehabilitation Service.
2. Terms of Reference
2.1. The group proceeded to review the Terms of Reference that had been set out for the working group, the Chair called for any comments.
2.2. The tight timescales were mentioned, as well as the current overview of the life of this group including how many meetings are expected to happen. The report is due in the autumn of 2020, but it was raised that this timescale could be slightly flexible.
2.3. The main point that was brought up in regards to the Terms of Reference was focused on the scoping exercise that is to be undertaken of the 31 ADPs. It was mentioned that it would be helpful to ask the “if not/why not” question in addition to asking what is available in each area. This will enable the group to understand why areas haven’t invested in Residential Rehabilitation. There was agreement on this point.
3. Review of Evidence paper
3.1. The Chair went on to discuss the second paper that had been circulated prior to the meeting “Access to Residential Care: An overview of the evidence (July 2020)”.
3.2. After giving an overview of this paper, the Chair opened up the discussion to the members and welcomed any comments.
3.2.1. The main comments made focused on drawing examples of good practice and good framework for Residential Rehabilitation from other areas outside of Scotland for comparison. This was widely agreed by members, with additional points being made about looking at the comparison between peer-led and professionally-led services, as well as concerns about over-professionalised models.
3.2.2. It was also noted that the first priority was to interrogate the Scottish Landscape for Residential Rehab and to import best practice from across the world and should guide and be reflected in the report produced.
3.2.3. Others noted that it was important to acknowledge Residential Rehab where it has sprung up in a clinical setting, and drew focus to the importance of expansion and an increase in provision of service for those with complex mental health issues.
3.2.4. It was noted that there is a need to work more closely with mental health colleagues, specifically about ward admissions. Importance on how we use the term ‘professional’ was highlighted, as many of those who have lived and living experience would count themselves as professionals.
3.2.5. The Chair went on to agree with what was being said, especially about comparisons of good practice needed, especially in terms of cost-effectiveness. The cost-effectiveness of treatment was agreed by members, who also highlighted that whilst we want people sent to the right service for them, if more people could be sent to residential rehab for less, it would be better from a purchasing point of view
4. Residential Rehab Services in Scotland
4.1. The discussion then moved on to the distribution of residential services across Scotland and which areas sent more or fewer people to residential rehab.
4.2. It was highlighted that there was evidence available to show this pattern in each area, as well as how much it varied from the various Local Authorities. It was agreed that this information would be relatively easy to obtain and would be useful to have before the next meeting.
4.3. It was noted that the Recovery and Residential working group would be able to help supply this data. Members discussed the impact of siloing and localisation on residential rehab, as well as the impact of a ‘that is not my department’ mentality. It was highlighted how important it is to foster connections to improve the service and treatment pathway.
4.4. It was also noted that it would be interesting to capture the cost of residential rehabilitation and if anywhere offered subsidised/self-funding options, as this often has a large impact on families.
5.1. The discussion then moved on to talk about the importance and value of outcomes, taking a more patient-outcome approach rather than service-based outcome.
5.2. There was agreement, as well as call for an outcome measuring tool for residential rehab services. It was mentioned that services often feel difficult to get in and out of, as well as people having dignity issues, outcomes need to be person-centred.
5.3. There was also interest registered in enhanced housing benefit claims. It was suggested the Recovery and Residential working group could provide data on this. Non-clinical services, as well as those with limited or no medical infrastructure were also mentioned in terms of effectiveness and outcomes.
5.4. This created a larger discussion around services that are smaller and perhaps more ‘obscure’ and not listed in core services, such as Teen Challenge and Jericho House, it was suggested this creates barriers to accessibility and engagement with these services.
5.5. It was also noted that the group had to be mindful in terms of ‘Rights, Respect and Recovery’ and that people are more included in the decision-making process about what is right for them, taking a more rights based approach.
5.6. It was noted staff would need to understand their role in a different way, and that we need to be careful of how we use the term ‘well’, are the patients well in their eyes or the service providers? A need for more trauma-informed treatment was also highlighted.
6. Actions and Close
6.1. The Chair suggested a list of all residential rehab services was drawn up, with special focus on smaller service providers, with input from all the members via email. This would help provide an overview of where this group is starting from.
6.1.1. A few points were raised on what could be asked/collected data wise, this included people in residential rehab, how many completed their programme, detox, aftercare etc. This is something to focus on once the list of service providers has been drawn up.
6.2. The Chair also agreed on the trauma-informed practices and noted that this was a requirement that all services should be providing patients.
6.3. The Chair also asked for the discussions in the ‘chat’ of the call to be collected, the following points were made:
- the roll of DAISy in regards to outcomes once this has been implemented
- asking ADPs what Residential Rehab services there are available in their areas.
6.4. Finally, the Chair drew the meeting to a close, thanking each of the members for attending and for their valuable input. A doodle poll will be sent out to the members to ascertain the next available date for the next meeting.