In November 2012 an emergency summit was held to investigate why referrals of drug addicted patients to residential rehabilitation centres in Scotland were so low. The premise of the summit, hosted by the Scottish Recovery Consortium, was that residential rehab in Scotland would die out if the situation did not change.
What the summit found was a broad range of support for rehab — from patients, families, charities, politicians and addiction experts. The summit showed that rehab can be more expensive in the short-term but is still a cost effective treatment and, crucially, is the preferred course of treatment for many addicts.
Following this summit an official review of Scotland’s drug services was published. This review (Delivering Recovery-Opioid Replacement Therapies in Scotland, August 2013) was commissioned by the Scottish Government and confirmed that there is an urgent need to make more use of residential rehab services for people with addictions, and that little progress was being made in terms of treatment choice for patients.
“More people are seeking the residential option”, states the report. “A common response from service users was that many service users are offered little but Opioid Replacement Therapies.”
Other findings of the report were that:
- Use of residential rehabilitation facilities is extremely inconsistent across the country.
- In some areas of Scotland, little or no use was being made of residential rehab.
- 12 Step programmes have a positive impact on substance misuse outcomes.
- Services who dismiss the effectiveness of rehab are doing so based on their own audits rather than established research.
The independent expert review was led by Sir Harry Burns, the Chief Medical Officer for Scotland. The report is critical of the fact that Scotland’s addiction treatment services hardly use residential rehab, and when they do it is only as a last resort:
“In all areas who responded, use of residential rehabilitation was felt to be an option reserved for those who it was felt had not been able to make constructive use of other services. There is, however, no evidence to support this being the best use of residential rehabilitation as opposed to, for instance, being a first intervention based on expressed preference.”
Surprisingly, the report’s position only reiterates current government policy. According to Essential Care, a Scottish Government report from 2008, “community and residential rehabilitation as treatment choices should be offered to any persons requiring them in any locality.” There are many other references to this policy going back over the last 10 years which are highlighted in this article.
From the perspective of patients, families and rehab clinics this report is welcome, but it only confirms what they already knew. Local decision makers often overlook official policy on residential rehab, which can only be to the detriment of the people who need this form of treatment. Local community-based treatment services are often prioritised ahead of the most appropriate treatment options such as rehab.
These are significant failings in Scotland localised addiction treatment services, and having them highlighted is a welcome development. But is there any incentive to change the status quo and offer people access to rehab?
The report states that some local Alcohol & Drug Partnerships (ADPs) recognise that residential rehabilitation must be offered as a treatment choice. Other ADPs are said to be moving in the same direction.
The landscape may soon be changing. The report states that “It is likely that the HEAT targets will also expose limitations on access, as time allows more comprehensive information to be collected on residential rehabilitation – either as second and third treatment options or, indeed as a first treatment option for consideration alongside the more common choices of ‘preparatory counselling’, ORT and detoxification.”
HEAT stands for Health Improvement, Efficiency, Access to Services and Treatment. HEAT targets are the NHS performance management system and NHS Boards are accountable to the Scottish Government for achieving these targets.
What this suggests is that the Scottish Government will be monitoring access to residential rehabilitation services, and that local services will be expected to show that access to rehab is being offered to a higher proportion of patients who need and request it – even as a first treatment option. As this information is collated and published, it will give the government, the public and the treatment sector the information they need to hold the ADPs to account.