Medway Inpatient Detoxification and Residential Rehabilitation Insights Project
Task
Medway Council commissioned TONIC to conduct an insights project into the demand, availability, uptake, barriers to access, and impact of inpatient detoxification and residential rehabilitation for people who use substances and are residents in Medway. Additionally, TONIC were asked to explore commissioning options available to the local authority for effective inpatient detoxification and residential rehabilitation services. Ultimately, the aim of this project was to inform future commissioning decisions for inpatient detoxification and residential rehabilitation services and help to develop a plan to enhance the uptake and success of these services, contributing to Medway's local drug strategy.
Our Approach
Firstly, in order to undertake a desktop literature review, a number of sources and databases were consulted. This incorporated national guidelines such as the National Institute for Health and Care Excellence (NICE), as well as Government publications including the most recent drug strategies and the independent review conducted by Dame Carol Black. In addition, academic, peer reviewed journals were considered which afforded consideration to outcomes after inpatient detoxification or residential rehabilitation.
In terms of primary research, TONIC used a mixed-methods approach; analysing quantitative data shared with us by the provider or available via the National Drug Treatment Monitoring System (NDTMS) and conducting in-depth qualitative interviews and focus groups with service provider staff and management, external professionals, commissioners, and those with lived experience. In total, TONIC engaged 48 individuals:
14 external professionals
9 service provider staff
25 individuals with lived experience.
Once the quantitative and qualitative data collection had been completed, the TONIC team came together for a series of triangulation workshops. The aim of these was to bring together data from multiple sources and identify emerging themes, which structured the findings section of the final report.
As part of the triangulation process, TONIC undertook an exercise to produce journey maps to depict the experience of a service user and Recovery Worker during the pathway to accessing inpatient detoxification or residential rehabilitation. A journey map is a visual representation of an individual’s experience within a service or a pathway. Journey maps are diagrams that typically include touch points, pain points, and opportunities, plotted in sequential order. The goal of journey mapping is not just to create a timeline, the aim is to provoke empathy and provide a clear vision for improving a service user’s experience.
Outcome
TONIC produced a comprehensive report detailing the findings from the quantitative data analysis and qualitative fieldwork. The report explored the available capacity and current uptake of inpatient detoxification and residential rehabilitation in Medway, before examining the perceived demand for these services. In addition, the report outlined some of the existing barriers to accessing inpatient detoxification and residential rehabilitation, with corresponding proposed solutions, and discussed the feedback received from participants on the current pathway. Some of these key findings are summarised below:
The perceived demand for inpatient detoxification and residential rehabilitation in Medway reportedly outstrips capacity.
Barriers to accessing and engaging with inpatient detoxification and residential rehabilitation are wide-ranging, including strict eligibility criteria, anxiety around unfamiliar settings, and a need to evidence commitment.
Recovery Workers may struggle to coordinate the process due to already high workloads.
There is a need to expedite the process so that delays and waiting times are kept to a minimum in order to keep service users motivated and engaged.
There are opportunities to improve transparency and multi-agency involvement in tier 4 panel decision making process.
Holistic, multi-agency aftercare planning and peer support are vital to maintaining recovery, but current provision is inconsistent.
In October 2024, TONIC attended the Medway Combatting Drugs Partnership Conference in Gillingham and presented some of the emerging themes to key stakeholders.