SUBSCRIBE
RESIDENTIAL
REHABILITATION
The government’s CSCI and
NTA carried out a review of
treatment services last year –
inspector David Finney explains
Last year, I brought news that residential
rehabilitation services delivered good-quality
care compared with other care sectors that
were inspected by CSCI, the Commission for
Social Care Inspection. Since then, there has
been a year of activity when Tier 4 services
have come under scrutiny from the National
Treatment Agency for Substance Misuse
in its Improvement Review. There has also
been much debate about their integration
with the whole drug treatment system, their
largely abstinence-based philosophy and
their position in the market place.
So, what is the story this year? Has this position
been maintained? What factors could aff ect the
survival of residential rehabilitation services?
Th e story is that the news this year is even
better than last year. In a statistical survey of all
the residential services registered with CSCI,
residential rehabs have improved over the year
and outstrip other sectors in every outcome group
we measure.
Th e following table gives some basic fi gures
which are of interest. Th e percentages refer to the
meeting of national minimum standards for each
outcome group.
Outcome groups 2006/7 2007/8 Nat average
Choice & control 90% 94% 89%
Fulfi lment 97% 98% 94%
Health & wellbeing 87% 90% 85%
Management, staffi ng 78% 83% 81%
Safeguarding 80% 85% 81%
Quality assurance 82% 85% 76%
Overall 86% 89% 85%
Th ese results represent a major achievement
in terms of delivering quality care for people in
recovery. All these outcome groups are important
for people residing there – but a few words about
each will illustrate the good work done by rehabs
during this time.
CHOICE AND CONTROL.
Key features aff ecting choice are the quality of
information provided before admission as well
as the depth, professionalism and service-user
involvement in the assessment process.
ADDICTION T DAY
Once a person
takes the step to be
admitted, the extent to
which they are able to exercise
control over their own decision-making
and risk-taking is assessed. Inspectors were clearly
convinced that rehabs embedded this in their
practice. Furthermore, people in recovery were
able to recount their experiences of choice and
control in an understandable way.
HEALTH AND WELLBEING.
Inspectors observed very good relationships
between health professionals and rehabs, leading
to physical and emotional needs being very well
met. In the days of increasingly complex needs
being presented by people coming to rehabs, this
is very good news.
Care planning is key to this outcome, with
active involvement of people receiving the service
at both the planning and the review stages
particularly commended by inspectors. Th e
philosophy of “person centred planning” is seen
as central to rehabilitation as well as linking in
well with Local Authority expectations of care
planning. Th is results in the care pathway being
more likely to be continuous.
MANAGEMENT AND STAFFING.
A safe recruitment process and a high proportion
of well-qualifi ed staff reassures people in recovery
that they will receive good-quality care when in
residential rehab. Of central importance is the
calibre of the managers.
Inspectors were particularly impressed
with their professionalism, approachability and
staff -management abilities. Th e manager has
to go through a rigorous registration procedure
with CSCI, thus ensuring that they have a full
understanding of the role and accountabilities
incumbent upon them. From experience, I would
say that a good manager unfailingly ensures a
good service and a better outcome for people
using the service.
WWW.ADDICTIONTODAY.ORG
SAFEGUARDING.
It is important that
people in recovery feel safe. Th is
is achieved through a good understanding
among staff about how to listen to complaints and
when to involve local safeguarding procedures.
Th e quality of the environment is important
in terms of health and safety, hygiene to reduce
the risk of cross infection and comfortable living
areas to ensure the stay is a convivial as possible. In
my view, rehabs have made major steps forward in
recent years to bring about these improvements.
FULFILMENT.
It is particularly gratifying to see that the
treatment programmes are seen to be delivering
good opportunities for personal development.
People spoken to by inspectors confi rmed that
this was the case. People’s rights are adjudged
to be respected and the development of their
personal and family relationships are seen to be
appropriate to their recovery.
Th is is important to note, as sometimes
rehabs are seen as remote. But the evidence from
inspection is that rebuilding relationships is well
addressed in those that are inspected by CSCI.
QUALITY ASSURANCE.
Inspectors focus particularly on the quality of
the involvement of people using services and
on the way in which this feedback is formed
into a development plan for the running of the
unit. Th ere is now a requirement to complete an
Annual Quality Assurance Assessment, AQAA,
for registered services. Th is asks for a selfevaluation
of what works, what has improved
and what is needed to be done over the next
12-month period.
Inspectors assessed this sector as outstripping
the rest of the care-home sector by a considerable
margin, illustrating a well-developed ability to
be self-refl ective and concentrate on continuous
improvement.
CONTINUED...
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