Scottish Government

2.3 Governance and Accountability of the Delivery System

Comment:

Delivery Reform ⁴ has created a new local delivery system with the aim of increasing the likelihood that the aspirations of The Road to Recovery will become a reality. The Scottish Government has put substantial effort into support for this. Investment in the Alcohol & Drugs Action Teams ( ADATs), now ADPs, structure is significant and this ring-fenced investment reflects a considerable priority being given to the issues of substance use by the Scottish Government. In addition, acknowledging that previous attempts to improve ADAT performance have not seen consistent and sustained improvement ², the Government's Delivery Reform process delivered a range of additional supports to allow better engagement with SOAs (an Outcomes Toolkit³); advice on self-assessment to guide an improvement agenda ( Audit Scotland²); experienced national officers to guide ADPs who were struggling ( National Support Co-ordinators) and a new national organisation - SDRC - to give specific support, leadership and advice around the recovery agenda. New national information systems would improve data on effectiveness (Information Services Division and its Scottish Drug Misuse Database).

The aim of this process was to ensure that the new ADPs would not be isolated but would become an effective integral part of the CPP. Redundant Corporate Action Plans would give way to generic accountability for the key partners - through NHS accountability (including a new HEAT access target) and SOAs (aided by the Outcomes Toolkit). Despite this change, funding would still be ring-fenced - at least initially - to reduce the risks that local partnerships may not prioritise this area of work. Generic ADPs would be subject to generic accountability - so generic scrutiny organisations - Social Work Inspectorate Agency ( SWIA), Her Majesty's Inspectorate of Education ( HMIE), Quality Improvement Scotland ( QIS) [or their successors] would have a role in ensuring maintenance of acceptable standards.

Delivery Reform created a new system of delivery, in response to the criticisms of performance in the Audit Scotland report ². This local redesign was supported by significant national investment. Given the time that has elapsed since the establishment of ADPs and the inputs and investment that the Scottish Government has made in this area, the DSDC believes that ADPs should now be in, or close to, a position to demonstrate impacts in terms of key inputs, outputs and outcomes. In particular:

• ADPs should be able to demonstrate that assessment and regular measurement of recovery capital underpins individual treatment plans;
• ADPs should be able to evidence that progress in a number of basic inputs is completed including the Audit Scotland self-assessment, local needs assessments and local strategies coherent with the findings of the local needs assessment and focused on outcomes.

In response, the DSDC makes the following recommendations:

2.3.1 Demonstrating Impact

• ADPs should be able to demonstrate that assessment and regular measurement of recovery capital underpins individual treatment plans.
• ADPs should be able to evidence that progress in a number of basic inputs is completed now in all areas, including the Audit Scotland self-assessment; local needs assessments; and, a local strategy coherent with the findings of the local needs assessment and focused on outcomes.
• There is an urgent need to report on progress in a number of basic outputs which should be completed in timeframes agreed with the Scottish Government. These include: all areas should have clear systems to demonstrate improved choice; should be able to demonstrate significant meaningful involvement of service users in service planning and governance; should be engaged with the SDRC and its support activities; and should have quality assurance processes in place - in line with Essential Care.
• ADPs should be able to evidence that agreed national core outcomes are adequately represented in the Community Planning process and baseline data on performance/impact should be available from which progress can be determined in subsequent years .

2.3.2 Prioritisation of Substance Use Issues by Quality Assurance Organisations

When the DSDC was discussing scrutiny arrangements, we were conscious of the considerable re-organisation and re-structuring underway with regard to arrangements for national scrutiny on many important agendas. Also, Quality Improvement Scotland ( QIS) had no specific processes in place to oversee NHS activity relating to substance misuse. The DSDC believes there is risk to successful implementation of the Road to Recovery associated with the forthcoming change of scrutiny processes. There is a need to balance governance procedures to ensure that robust oversight is a component of the new arrangements in all key organisations - reflecting the high prevalence and complex cross-cutting nature of the problem.

In response, the DSDC makes the following recommendations:

• Ministers should continue to highlight substance use service delivery and leadership as a priority for national scrutiny processes ensuring that substance misuse is a priority element of inspection activity.
• An NHS process to improve governance and delivery of treatment services for substance users should be pursued with some urgency .