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2. Strategic Context
This section contains the Government's response to recommendations which have been made to improve strategic planning of essential care.
Recommendation 1 - Governance and accountability processes
In its strategic approach to problem substance use, the Scottish Government should develop and introduce governance and accountability processes which scrutinize local performance in terms of both reducing harm and promoting recovery. These processes must ensure that all elements of care which may be required to support recovery have in place agreed contractual levels of activity and performance monitoring - including relevant outcome measurement.
These governance and accountability processes could be delivered through a national quality improvement unit working in association with reconstituted ADATs.
Government response
A joint "delivery group," consisting of members of SACDM and the Scottish Ministerial Advisory Committee on Alcohol Problems ( SMACAP) has been established to advise on the future of delivery arrangements. Key elements of the group's remit are to:
- Develop and propose an outcomes based framework for assessing and managing performance at a local level; and
- Develop and propose robust accountability arrangements between central Government and partner organisations.
The Government will publish and respond to the conclusions of the group in time to allow its work to inform accountability arrangements from April 2009.
The Road to Recovery outlines the Scottish Government's intention to establish a national support function as a means of taking forward the developments contained in the strategy - in particular, the development and implementation of a recovery approach to treatment and rehabilitation. The delivery reform group will be invited to propose specific functions and priorities which the national support function should provide.
Recommendation 2 - Availability of interventions
In its strategic approach to problem substance use, the Scottish Government should require that all areas demonstrate the local availability of a full range of the essential interventions listed in this document and that service providers are engaging service users in approaches aimed at promoting recovery.
Government response
A key aim of the delivery reform group is to develop and propose arrangements for delivery which, as far as possible, ensure that local decisions on the mix of treatment and rehabilitation services are based on evidence, including how effective they are in meeting identified need.
Recommendation 3 - Recovery network
In its national strategy, the Scottish Government should bring forward options for establishing a Scottish Problem Substance Use recovery network.
Government response
The Road to Recovery outlines the Scottish Government's intention to establish and support a Problem Drug Use Recovery Network designed to bring about changes similar to those achieved by the Scottish Recovery Network in the mental health field.
We will bring forward proposals for activity related to a drug misuse recovery network to promote and support the concept of recovery among local partners, service providers and people with problem drug use.
Recommendation 6 - National strategies
The Scottish Government should ensure that problem substance use is addressed explicitly in its national strategic plans addressing general health improvement, health inequalities and social exclusion/regeneration programmes. In response, local health improvement partnerships must have in place a coherent plan which clearly states the priority given locally to issues associated with problem substance use and lays out the local actions which will be taken to address these.
The Road to Recovery recommends better integration of problem drug use within other national and local plans and strategies.
The Scottish Government is working with national partners to revise advice to Health Boards, Community Health Partnerships, Local Authorities and Community Planning Partnerships on planning to improve health and reduce health inequalities. This will be aimed at enabling effective collaborative working to meet national and local health improvement priorities.
The Ministerial Task Force on Health Inequalities, chaired by the Minister for Public Health and involving Ministers across government portfolios, is considering the underlying causes of key health inequalities, such as drug and alcohol problems. The Task Force will comment as part of its conclusions on delivering improvements at national and local levels. Better Health, Better Care (4) also outlines the Scottish Government's commitment to support drug treatment services and work with partners to introduce a new drugs strategy and delivery framework in 2008.
Recommendation 7 - Involvement of primary care
The Scottish Government should bring forward plans to improve primary care involvement in the full range of General Medical Services interventions relevant to problem substance use. Scottish Government plans should include exploration of and the use of the GMS governance arrangements to improve performance and encouraging synergy between the elements of care addressing problem substance use and substance use/Blood Borne Viruses.
Government response
Substance misusers are entitled to and should receive general medical services from their registered GP practices as for other patients. Specialised or specific drug use related treatment such as substitute prescribing, screening and vaccination for blood borne viruses and liaison with other services is provided by GP practices through the National Enhanced Service for patients suffering from the effects of drug use. Boards should ensure that practices providing these services comply with the requirements of the enhanced service. This could be through specific monitoring and feedback to practices about their treatment of drug users and ensuring compliance with staff training requirements.
NHS Boards have been provided with funding to deliver alcohol brief interventions with the aim of reducing alcohol consumption and related harm. It is intended that these brief interventions should become part of the standard services offered by NHS Scotland and primary care is a priority setting for their delivery.
The Road to Recovery recommends that Health Boards ensure that there is an appropriate level of service capacity, to work with partners including pharmacies to provide co-ordinated and holistic care and to ensure that data collection and ongoing evaluation of treatment is carried out.
Recommendation 8 - Workforce development
The Alcohol and Drugs Workforce Development Action Plan should take due cognisance of the need to develop staff in the full range of competencies to assist recovery. Attention should be given to more skill-based approaches dealing with values, attitudes and the delivery of psychological therapies at all levels of staff engagement with service users.
Government response
The Road to Recovery requires the principles of recovery to be reflected in training and workforce development programmes, in particular the developing Scottish Alcohol and Drugs Workforce Development Strategy.
The Scottish Alcohol and Drugs Workforce Development Strategy Steering Group, chaired by NHS Health Scotland, is in the process of creating a co-ordinated national training and development strategy to support a competent, confident, valued and responsive workforce. The group aims to publish its strategy in late 2008 and an implementation plan in Spring 2009. This recommendation can be considered as part of this work.
Recommendation 11 - Housing and homelessness
Mechanisms should be put in place to consolidate a Scottish strategy for integrating local housing, homelessness and problem substance use services. This must include approaches which assist settlement of individuals and the maintenance of tenancies.
Government response
The Homelessness and Substance Misuse Advisory Group comprised of key stakeholders has commissioned research to investigate how effectively services accessed by substance misusers contribute to reducing the level of homelessness in Scotland. The main objective of the research is to identify models or approaches that produce positive outcomes for people with substance misuse problems who are homeless or at risk of homelessness.
The Advisory Group will consider any recommendations from the research, disseminate them widely and work with the Government to consider future strategy.
Recommendation 14 - Criminal justice interventions
Community Justice Authorities ( CJAs) in association with ADATs must have in place a written strategy which describes clearly how targeted criminal justice resources will be used to increase access to treatment services as an option for the courts and for those sentenced to custody. Priority must be given for them to access services on return to the [non- CJS] community.
Government response
CJAs are independent statutory bodies with a duty to consult their partner areas, including NHS Boards, in developing their area plans. CJAs cannot be instructed to have particular written strategies in place. Most CJAs will be developing better working links with relevant ADATs, as outlined in their 2008-2011 area plans. The Scottish Government endorses this approach and expects that publication of this report will encourage the development of links to allow CJAs and ADATs in partnership to determine how local needs might best be addressed.
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