Drugs and alcohol workforce action plan 2023 to 2026

Section A - The Drugs and Alcohol Workforce Context

Scotland’s Health and Social Care Workforce

The ‘National Workforce Strategy for Health and Social Care in Scotland’^[4], published in partnership with COSLA, details that over 400,000 skilled and compassionate people deliver Health and Social Care services throughout Scotland across many different roles and settings. As the largest workforce in Scotland, they reach into every aspect of life and community.

The ‘National Workforce Strategy for Health and Social Care in Scotland’ sets out a national framework to achieve a vision of a sustainable, skilled workforce, across the entire Health and Social Care sector, with attractive career choices where all are respected and valued for the work they do.

The strategy acknowledges the significant pressures faced by the Health and Social Care workforce and sets out that sustained action is required to support workforce development.

The strategy sets out the evidence base and actions that will be taken forward to achieve the vision of a sustainable workforce, these include:

• Increasing front line health spending;
• Establishing a centre for workforce supply;
• Delivering a workforce which is inclusive, diverse and reflective of the communities that it cares for and supports;
• Increasing the number of medical school places;
• Recruiting additional Primary Care staff, including GPs and pharmacists;
• Supporting nursing and midwifery training costs; and
• Increasing Local Authority Social Work capacity.

The drugs and alcohol workforce forms a key part of Scotland’s wider Health and Social Care workforce. Almost all of the challenges impacting upon the wider Health and Social Care workforce also, consequently, impact upon those delivering drugs and alcohol services. Delivery of those actions identified in the ‘National Workforce Strategy for Health and Social Care in Scotland’ will therefore positively impact on the drugs and alcohol workforce.

Key Point: This Action Plan will not reiterate those wider actions detailed in the ‘National Workforce Strategy for Health and Social Care in Scotland’. Instead, the focus of this Plan will be on setting out the specific actions which will be progressed to address the particular challenges faced by the drugs and alcohol workforce.

This ‘Drugs and Alcohol Workforce Action Plan’ (hereafter referred to as the ‘Action Plan’) does, however, use the framework of the ‘National Workforce Strategy for Health and Social Care in Scotland’ by presenting all current or future actions under the key five pillars of:

1. Plan

2. Attract

3. Train

4. Employ

5. Nurture

The National Mission to Reduce Drug Deaths and Improve Lives

In January 2021, the previous First Minister set out our National Mission to reduce deaths and improve lives impacted by drugs. In August 2022, the ‘National Mission on Drug Deaths: Plan 2022-2026’^[5] was published. The plan set out that we will reduce drug deaths and improve lives through preventing people from developing problem drug use; reducing harms from the consumption of drugs; getting more people into high quality treatment and recovery services; addressing the needs of people with multiple and complex needs; and supporting families and communities affected by problem drug use.

Our Outcomes Framework, developed with stakeholders, reflects the objectives of the National Mission. Delivery of this National Mission is dependent upon having a skilled, resilient workforce. It is vital that services are able to attract, retain, and support staff to have the right skills and knowledge to support people who use drugs and alcohol.

National Drugs Mission outcomes framework

Cross-Cutting Priorities

• Lived Experience at the Heart
• Equalities and Human Rights
• Tackle Stigma
• Surveillance and Data Informed
• Resilient and Skilled Workforce
• Psychologically Informed

Reduce Deaths and Improve Lives

01 Fewer people develop problem drug use

a) Young people receive evidence- based, effective holistic interventions to prevent problem drug use

b) People have early access to support for emerging problem drug use

c) Supply of harmful drugs is reduced

02 Risk is reduced for people who take harmful drugs

a) Overdoses are prevented from becoming fatal

b) All people are offered evidence-based harm reduction and advice

03 People at most risk have access to treatment and recovery

a) People at high risk are proactively identified and offered support

b) Effective pathways between justice and community services are established

c) Effective Near-Fatal Overdose Pathways are established across Scotland

04 People receive high quality treatment and recovery services

a) People are supported to make informed decisions about treatment options

b) Residential rehabilitation is available for all those who will benefit

c) People are supported to remain in treatment for as long as requested

d) People have the option to start medication- assisted treatment from the same day of presentation

e) People have access to high standard, evidence- based, compassionate and quality assured treatment options

05 Quality of life is improved by addressing multiple disadvantages

a) All needs are addressed through joined up, person centred services

b) Wider health and social care needs are addressed through informed, compassionate services

c) Advocacy is available to empower individuals

06 Children, families and communities affected by substance use are supported

a) Family members are empowered to support their loved one’s recovery

b) Family members are supported to achieve their own recovery

c) Communities are resilient and supportive

Who are the Drugs and Alcohol Workforce?

Defining the drugs and alcohol workforce is not straight forward. The workforce is complex, spanning a range of employers (including NHS, third sector, Health and Social Care Partnerships, and Local Authorities) across Scotland. Many different organisations and individuals (e.g. public, private, third sector, families, communities) work with people who use drugs and alcohol. The wider workforce can include those in social work, hospitals, community pharmacy, general practices, education, health, police, and the community.

The picture is often complex and multi- level with several tiers of services working to support people who use drugs and alcohol as detailed in the following diagram:^[6]

Tier 1

• Interventions include provision of drugs and alcohol related information and advice, screening, and referral to specialised drug treatment.
• Interventions are provided in the context of general health, or social, care settings, education or criminal justice settings where the main focus is not drugs and alcohol treatment.

Tier 2

• Interventions include provision of drugs and alcohol related information and advice, triage assessment, referral to structured drugs and alcohol treatment, brief psychosocial interventions, harm reduction interventions and aftercare.
• Other typical settings to increase access are through outreach (street work, peripatetic work in generic services or domiciliary (home) visits) and in primary care settings.

Tier 3

• Interventions include provision of community-based specialised drugs and alcohol assessment and co-ordinated care planned treatment and drugs and alcohol specialist liaison.
• Interventions are normally delivered in specialised drugs and alcohol treatment services with their own premises in the community or on hospital sites.
• Other delivery may be by outreach (peripatetic work in generic services or other agencies or domiciliary or home visits). Tier 3 interventions may be delivered alongside Tier 2 interventions.

Tier 4

• Interventions include provision of residential specialised drug and/ or alcohol treatment, which is care planned and care coordinated to ensure continuity of care and aftercare.

Those working across all four tiers provide vital support and treatment. We fully recognise and appreciate the critical role that many professionals working in services, such as social work, pharmacy, prison, homelessness and primary care play in supporting people who use drugs and alcohol. They are an integral part of the system. We cannot prevent deaths and improve lives without them.

In order to ensure a targeted approach, delivering greatest impact, the primary focus of this Action Plan will be on those who deliver Tier 3 and 4 services, alongside those in Tier 2, who provide advice and information to people who use drugs and alcohol.

Key Point: For the purposes of this Action Plan, when we refer to “the workforce” we mean all those, regardless of sector, who identify drugs and alcohol treatment as being the primary part of their role.

Where delivery of identified actions can support those in Tier 1 services, who are not a specialist or practitioners in drugs and/or alcohol services but have the opportunity to positively address drugs and alcohol use through their paid or unpaid work, then this is clearly welcomed.

Our approach is in no way intended to diminish or undermine the contributions of those in Tier 1 or 2 services, instead this approach has been adopted in order to ensure our actions achieve the greatest impact for the people who use drugs and alcohol.

Our Vision for the Drugs and Alcohol Workforce

Effective planning is key to delivery of a well-supported, trained, and resourced workforce capable of meeting the needs of people who use drugs and alcohol.

Our vision for the drugs and alcohol workforce is:

“To develop a sustainable, trauma- informed, skilled workforce with the capacity to deliver a person centred, rights based approach. To develop a workforce which is confident, valued for the work it does and is fully empowered to prevent drug and alcohol related deaths and improve lives.”

Our workforce vision is aligned with the principles of Fair Work, and the Scottish Government’s broader strategic aim to become a leading Fair Work Nation by 2025, where fair work drives success, wellbeing and prosperity for individuals, businesses, organisations, and society.

What are the Challenges facing the Drugs and Alcohol Sector?

Whilst, as detailed earlier, the challenges impacting upon the workforce are often similar to those faced in the wider Health and Social Care sector, they are in many instances more pronounced, with a number of unique and specific challenges^[7] presenting. These challenges can be categorised into the three key themes of recruitment, retention, and service design.

Recruitment

The Scottish Government’s ‘Alcohol and drugs workforce: mixed-methods research compendium’^[8] (hereafter referred to as the ‘workforce research compendium’), published last year, indicated a sector- wide vacancy rate of 8.8% as of November 2021. This was higher than vacancy rates amongst allied health and medical professions overall. The challenges were found across a variety of roles and organisation types.^[9]

Public Health Scotland (PHS) also reported that ADPs have experienced delays in being able to fully implement the MAT standards due to recruitment challenges.^[10] The Corra Foundation, who support the Scottish Government with their funding processes as part of the National Mission, report that delays in the commencement of 15% of funded projects between April 2022 and March 2023 were attributable to recruitment issues.

We know that negative perceptions of employment in the sector can prove detrimental to recruitment.^[11] Whilst we know that those who use drugs and alcohol too often face stigma, the workforce research compendium highlighted that those working in services can often also feel stigmatised.

The Drugs Death’s Taskforce ‘Changing Lives’ Report (hereafter referred to as the ‘Changing Lives’ report) highlighted a need to ‘tackle the stigma experienced by the workforce and ensure they are given the recognition they deserve as front-line health workers.’^[12]

We know that awarding short term funding to services can dissuade potential applicants. This is an issue which can negatively impact on both recruitment and retention.^[13] Another key challenge impeding recruitment is the lack of career pathways into the sector – this is exacerbated by the lack of further or higher education courses which specifically focus on drugs and alcohol use.^[14]

We know that in many instances, the skills and knowledge of people with lived and living experience are not being fully utilised.^[15] We know that often requirements for specific qualifications or work experiences can act as a barrier for this cohort being able to satisfy their suitability for many advertised roles.

Retention

Workforce retention remains a significant challenge. Whilst it is critical that we ensure that the sector is a more attractive destination for potential employees; recruiting more staff without steps to improve retention would not lead to a sustainable workforce. Such an approach would make existing issues worse, with continual recruitment draining time from those already working in services.

It is an uncomfortable reality that one of the major drivers behind workforce attrition is that too many staff feel under increasing pressure. Both recruitment and retention challenges are impacting upon the number of staff available to deliver lifesaving treatment. As a consequence, caseloads are growing larger and ever more challenging. Whilst simultaneously those who engage with services present with increasingly complex needs. As a result, staff, particularly those in Social Work, often have to manage significant levels of risk from an adult support and protection perspective, in addition to managing existing risks of harm from drugs or alcohol use.

Services operating with higher caseloads results in staff having less time to undertake important tasks and some may therefore only focus on documenting information about issues posing the highest level of risk, at the expense of factors such as housing or employment. This can lead to some in the workforce not being able to develop a holistic perspective of service users’ lives. Consequently, opportunities for meaningful intervention are lost. This can lead to significant levels of mental and physical stress on staff, burnout and ultimately attrition.

We know that high rates of sick absence often leads to those remaining colleagues being required to absorb the caseloads of those who are absent. The workforce research compendium reported a statistically significant association between increases in average caseload and the number of sick absence days taken.^[16]

We know there are often too few opportunities for staff to progress in their careers. Whilst the vacancy rate is highest within front line service delivery roles, the workforce research compendium showed that the third lowest vacancy rates in the sector were for service managers at 2.1%.^[17]

The research also outlines a lack of opportunity for learning and development. Although data does suggest enrolments on Continued Professional Development courses have increased across drugs and alcohol topic areas, there are too few formal qualification routes and specialised courses for non-clinical staff.^[18]

We know that geography can be a barrier to the uptake in professional development opportunities.^[19] Although much training has migrated to online platforms, some training cannot be delivered online and this can be a challenge for those working in services in more remote areas of Scotland. Training and development was outlined in the ‘Changing Lives’ report as being key to enhancing staff wellbeing and the quality of the workforce.^[20]

Service Design

ADPs liaise directly with local services, providing advice to integration authorities on how drugs and alcohol services should be delivered by the NHS and local authority. Although this enables services to respond to local need, it can lead to wide geographical variation in the way services are designed and delivered.

We know that across Scotland there is significant variance in terms of the services and specialisms that are available. Often services are stretched, particularly in rural areas.^[21] The workforce research compendium and the associated survey of services reported that 13.6% of responses highlighted the necessity of service review and redesign of some drugs and alcohol services.^[22]