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1. Introduction
The Scottish Government welcomed Essential Care (1) when it was first published on 26 March 2008. The report complements other documents commissioned by the Scottish Advisory Committee on Drug Misuse ( SACDM) addressing treatment and care for people with problem drug use, which have been influential in the development of the Government's new vision for tackling drug use in Scotland.
Essential Care builds on work carried out as part of the review of the place of methadone in drug treatment in Scotland. The SACDM Methadone Project Group produced Reducing harm and promoting recovery (2), published in July 2007. Its main conclusion was that methadone has a key role to play in treating opiate dependency, but that the quality, consistency and delivery of methadone could be improved.
In scrutinising Reducing harm and promoting recovery, SACDM considered that there was a need for some work around delivery of additional support. Accordingly, a working group was set up under the auspices of the SACDM Integrated Care Project Group, chaired by Tom Wood, chair of Edinburgh Alcohol and Drug Action team ( ADAT) and of the Scottish Association of Alcohol and Drug Action Teams ( SAADAT). The aim of the working group, was:
- to review current Scottish and UK guidance on the range and effectiveness of available interventions;
- to clarify the evidence base;
- to comment on what we know about Scottish services, including examples of good practice; and
- to identify gaps and make recommendations on solutions
The working group included professionals and representatives of service providers from the statutory and voluntary sectors in the fields of physical and mental health, social work, employment, criminal justice and legal services. They met five times between September and December 2007. In reviewing the current position the group came to three major conclusions which are at the heart of their recommendations. These are:
- that recovery should be the main focus of treatment and rehabilitation for people with problem drug use and that this focus should be embedded at all levels, from national strategies to local commissioning and monitoring of services and assessment and care of individuals;
- that generic services have as much of a role to play in the recovery of these clients as services treating the more immediate impact of addiction, since the recovery process means addressing the whole of people's lives; and
- that systems of governance and accountability both locally and nationally need to ensure that people with problem drug use can expect the same prospects for recovery as other people seeking help to overcome other complex needs.
The Government accepts the recommendations of Essential Care. The central vision of Scotland's new drug strategy The Road to Recovery (3) is built around them and considers that implementing these recommendations is critical to our future success in tackling problem drug use. Chapter 3 of the strategy outlines how the Government will continue to promote and make the case for adopting this approach. Chapter 6 describes how recovery is built into the reform of delivery arrangements which is necessary to bring about the changes needed.
We are extremely grateful to the members of the Essential Care Working Group who took time out of busy lives to produce this report in the space of only four months. The report has both reflected widespread opinion that a new philosophy of care is needed for people with problem substance use and provided a clear direction towards a recovery-based approach. Its influence on The Road to Recovery is clear.
The recommendations outline opportunities to make improvements in both strategic and more practical terms. The challenge now is for all stakeholders to be involved in addressing the issues raised, to establish a person-centred approach based on the belief that people can use the strengths they already possess to move into recovery and rebuild their lives. This should become the accepted goal of treatment and care.
This response addresses each of the 15 recommendations, outlining both current and planned action by the Government and its delivery partners. Parallel work in policy areas across the Government which support the implementation of the recommendations have also been highlighted. Recommendations which require strategic planning at national and local levels are dealt with in Section 2. Those which deal more directly with the care and support given to individuals in order to maximise recovery are grouped together in Section 3.
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