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Residential rehabilitation services in Scotland are regulated by appropriate governing bodies independent of the Scottish Government; namely the Care Inspectorate, Healthcare Improvement Scotland or the NHS.

It is the responsibility of these bodies to monitor and ensure that residential rehabilitation services are providing safe, quality support to people in recovery across the country.

The Scottish Government entrusts these bodies to carry out this responsibility diligently, and in line with the qualified levels of clinical expertise that they provide.

The Scottish Government commissioned Scotland Excel to develop a National Commissioning Framework to support the procurement of residential rehabilitation placements. The Framework launched in April 2024 and includes a service specification as part of the contractual arrangement. This service specification was developed in conjunction with the regulators to ensure a minimum level of care provided by each provider on the framework.

The Public Health Scotland interim monitoring report on statutory-funded residential rehabilitation placements does not gather data on the number of successfully completed rehabilitation placements.

We have responded to calls for more transparency and accountability commissioning Public Health Scotland to develop a National Core Minimum Dataset that will provide data not only on the number of publicly funded placements but also with time will publish insights on outcomes from placements in Residential Rehab.

This will provide the Scottish Government with a clear line of sight on how residential rehab funding is being spent across the country and help to further the evidence base for this treatment model.

Public Health Scotland’s baseline report on the residential rehabilitation programme, published in February, outlines the complexities in evaluating shorter programmes within the context of wider residential rehabilitation.

As noted on Page 12 of the report, discussion as to whether two-week or four-week placements are best included or excluded from the total number of publicly funded residential rehab placements remains ongoing. The argument for including them is that they are publicly funded placements. The argument for excluding them is that there has been some evidence in previous reports such as the 2020 Residential Rehabilitation Working Group report which suggests that positive outcomes are more likely with longer placements.

However, all placements for residential rehab are assessed on an individual needs basis, and so we cannot assume that longer programmes necessarily constitute a comprehensive rehabilitation experience in general. It is ultimately for professionals and clinicians to make the decision locally as to whether a shorter programme is as effective for the individuals involved.

The Scottish Government published a capacity mapping report in 2021 which found that residential rehabilitation provision was disproportionally located around the Central Belt.

We acted on this by announcing the second round of the Residential Rehabilitation Rapid Capacity Programme in 2022, with a specific priority to support new or expanded residential rehabilitation facilities which were regional or would accept placements on a national level.

Over £14 million was made available to support the successful projects, which included the expansion of CrossReach’s service in Inverness (with outreach support to the Highlands and Islands), the extension and refurbishment of the Maxie Richards Foundation’s service in Tighnabruaich, and the creation of a new national residential rehab service in Aberdeenshire by Phoenix Futures.

These projects are progressing well and we expect all to be operational by the end of the year.

The Public Health Scotland’s Interim monitoring report on statutory-funded residential rehabilitation placements published on 18 July 2024, shows that during the period between October 2023 and March 2024 estimated costs for 33 placements to Ward 5 was £495,396 – averaging at £15,012 per placement.

The Scottish Government have allocated a £5 million uplift in funding to Alcohol and Drug Partnerships (ADPs) based on the National Resource Allocation Formula, for funding of residential rehabilitation placements and distribution of this fund at ADP and Health Board level is a local decision.

Public Health Scotland’s (PHS) most recent report confirmed that 461 statutory-funded placements were approved in the second half of the 2023-24 financial year alone, with 938 placements approved for the year overall. This indicates that we are already on track to meet our commitment of 1000 people accessing statutory-funded residential rehab in 2026 (an increase of 300%).

While the PHS statistics indicate welcome progress, we recognise the scale of the challenge that we continue to face and are determined to do more.

We are working with ADPs to aid the development of clear pathways into residential rehabilitation across the country, and the establishment of pathway development clusters by Healthcare Improvement Scotland has resulted in 29/30 ADPs publishing their pathways. This will help facilitate a further increase to statutory funded placements and support our aim of meeting the final target before the end of the National Mission in March 2026.

Public Health Scotland worked in close consultation with key stakeholders to develop the core minimum dataset, which will form the basis for the monitoring of residential rehabilitation. Early versions of the dataset were shared with the Monitoring, Evaluation and Research Advisory Group (MERAG) and the Residential Rehabilitation Development Working Group (RRDWG), which have representatives from groups such as individuals with experience, families and recovery organisations.

Current residential rehabilitation clients were given the opportunity to complete a survey to provide details of their own experience. Qualitative research was also undertaken with people with lived experience of having accessed residential rehabilitation to explore their experiences of the pathways into, through and out of this form of treatment.

A breakdown of how funding is allocated to ADPs since 2017 can be found on the Scottish Government website: https://www.gov.scot/publications/alcohol-and-drug-partnerships-funding-allocations/

The Scottish Government will address the impact of changes to service provision on access and availability to alcohol and drug recovery services by continuing to ensure that the specific needs of women are considered in the design and delivery of services, and that a gendered approach is taken in all new or developing initiatives across the National Mission to reduce deaths and improve lives.

The Scottish Government provided specific funding of around £1.5m per year to Glasgow City Council to support the 218 Service. As a result of that funding relationship, Glasgow informed the Scottish Government of its plans to re-tender the service last year and discussions took place to confirm that the funding would still be available following that exercise.

Glasgow City Council has provided assurances that it worked closely with Turning Point Scotland to support individuals in transitioning to other support arrangements and that other services, including residential placements, are available to support people with similar needs. In particular, it has confirmed that all 218 service residents had moved on from the service as of 31 January 2024 – some residents naturally came to the end of their stay, while others moved back to their own tenancy or to accommodation with support.

The Scottish Government remains committed to addressing the twin public health emergencies on alcohol and drugs and recognises the key role treatment and recovery services play.