Drugs and alcohol workforce action plan 2023 to 2026

Train

What is the wider challenge across the Health and Social Care sector?

The workforce needs supported to ensure they have the skills and education required to deliver services. Across Scotland our schools, colleges, universities and training providers deliver high-quality education to learners at all levels to support this.

Staff retention is essential for the delivery of consistent, high quality and safe services. To this end, the workforce requires opportunities for career progression. Career development both enhances the quality of skills in the workforce and improves retention through increased satisfaction and wellbeing. Work also needs to be done to raise the profile and value placed on careers in Health and Social Care. Training and continuous career development are central to this.

Work is required with partners, stakeholders, professional bodies and educational institutes to identify where new and innovative roles and training can enhance workforce capacity and capabilities.

What needs to change within the drugs and alcohol sector?

A set of key skills and experiences are needed for anyone working in drugs and alcohol services. These should, as a minimum, be focused on embedding care, compassion, and empathy in service delivery. The workforce should feel empowered to implement and fully embrace changes that mainstream these principles.

Approaches that encourage training to be delivered to groups, which include both professionals and people with lived and living experience, can be successful in reducing stigma and improving joint working. The workforce should be well informed on key aspects of the treatment and recovery system in their area. This should include the Near Fatal Overdose pathway and local referral processes.

Steps should be taken to support people who choose to work in drugs and alcohol services through targeted continuous career development. This should include shadowing opportunities, peer review, supervision and support. It should also provide defined career progression opportunities.

What have we done so far?

The Corra Foundation report that 95 projects awarded funding between April 2021 and March 2023 had invested in strengthening their workforce or supported skills development.

The ‘Changing Lives’ report detailed that, as a minimum, the workforce should be expected to have had sufficient training in the following five areas.^[31]

1. Taking a human rights-based approach;

2. Practising trauma-informed care;

3. Tackling stigma;

4. Delivering family-inclusive practice; and

5. Providing harm-reduction advice.

Whilst further additional competencies, values and training may be identified and embedded, work is already underway to facilitate workforce training uptake across those five areas. An overview of some of this follows.

1. Taking a human rights-based approach

Equality and Human Rights are cross-cutting priorities underpinning the National Mission. Through the new Human Rights Bill, work is also underway to incorporate into Scots Law the right of every person to attain the highest attainable standard of physical and mental health insofar as possible within the limits of devolved competence. As duty bearers, service providers will be required to ensure that the principles of a person-centred, human-rights based approach are at the heart of delivery.

The National Collaborative is a project that aims to empower people affected by substance use and set out how the right to be included in the forthcoming Human Rights Bill can be effectively supprted. It will do this by developing a Charter of Rights with people affected by substance use, service providers and government. The Charter will summarise key rights (existing rights and those proposed for inclusion in the Human Rights Bill) and how they might apply to people with problematic substance use. This will support people affected by substance use to know and understand their rights and to support duty bearers to continuously improve the availability, accessibility, acceptability and quality of their services.

The Charter will be used to strengthen individual and collective advocacy by, and on behalf of, people affected by drugs and alcohol in a range of contexts (i.e. in accessing treatment services but also in interactions with wider public services such as housing and employment). It will also be used to improve service delivery by those providing services and those responsible for commissioning services at a local level. At a national level the Charter will be a tool to inform prioritisation, policy development and decision making.

The roll out of the Charter will be complimented by training and capacity building with communities of people with lived and living experience and those working in services.

In order to support delivery of the MAT Standards and ensure a human rights based approach is embedded across local areas, REACH Advocacy have been funded by the Scottish Government to deliver their well-established REACH Advocacy Practice Award and MAT Standards as part of a Human Rights Based Approach Awareness Workshops in 2023/24. Corra have awarded REACH further funding to deliver this throughout 2024/25, 2026/26, and 2026/27. This cuts across a number of National Mission outcomes as well as various MAT Standards – particularly 3, 6, and 8.^[32]

This education and training allows frontline staff and managers across statutory and third sector services to develop knowledge and more effectively deliver the MAT Standards and adhere to Human Rights legislation. Additionally, it allows people with lived and living experience to understand their rights when accessing services.

2. Practising trauma-informed care

The Scottish Government understands that many people who use services have experienced trauma or adversity in their lives and may use drugs and alcohol as a way of coping with the impact. The Scottish Government is committed to ensuring that all services are trauma- informed and responsive in a way that supports people to access and remain engaged with services for as long as they need to; whilst ensuring staff can offer relationships which promote recovery.

We know from the ‘Changing Lives’ report that some staff felt that they needed more training in this area, specifically around appropriately responding to disclosures of past trauma. Evidence highlights that where the impact of trauma is understood by staff, and where systems are better designed to support, then barriers to engagement can be reduced and better outcomes achieved.^[33]

Trauma-informed approaches are a process of organisational change aiming to create environments and relationships that promote recovery and prevent re-traumatisation.^[34] The Scottish Government will support ADPs to ensure that all drugs and alcohol services are delivered in psychologically and trauma- informed environments as per Action 35 of the ‘Changing Lives’ report.^[35] Our ambition for a trauma-informed workforce and services across Scotland is shared with COSLA and many other partners.^[36]

Since 2018, we have invested over £9.6 million in our National Trauma Training Programme (NTTP).^[37] This has included £4.8 million of funding distributed to all local authorities, in 2021/22, 2022/23 and 2023/24, to work with community planning partners to further progress the development of trauma-informed services, systems, and workforces.

The Programme provides freely- available evidence-based trauma training resources (developed by NES). These can help raise awareness, knowledge, and confidence among the workforce to embed trauma-informed practice based on the key principles of safety, trust, choice, empowerment, and collaboration. This includes the ‘Alcohol and Drug Use and Trauma-Informed Practice Companion Document’^[38] which has been designed to support all professionals working with people affected by drugs and alcohol use and/ or their families and aims to strengthen awareness and understanding of trauma- informed practice. The NTTP has also designed a freely available e-module^[39] specifically focused on understanding the use of drugs and alcohol to cope with the impact of trauma.

In 2022/23 the NTTP also supported four pathfinder projects focused on trauma-informed substance use services (Dumfries and Galloway and Orkney) and trauma-informed maternity services (Forth Valley and Grampian). The aim of these pathfinders was to explore the support that is needed by frontline services to design and embed sustainable models of trauma informed care. Learning reports from the pathfinders will be published in 2023.

3. Tackling Stigma

There is a need to ensure that, across the whole system, all those who engage with people who use drugs and alcohol understand these issues. This will help break down the stigma which too often inhibits equitable treatment.

Stigma also reinforces trauma and prevents people from seeking support and treatment. It is therefore imperative that people who use drugs and alcohol do not face additional stigma once they take the often difficult decision to engage with services.

We know from the ‘Changing Lives’ report that the delivery of training to groups of professionals and people with lived and living experience has proved successful in reducing stigma and improving joint working.^[40] We would encourage services and training providers to maximise opportunities for such shared learning to be replicated and engage with available training opportunities, such as SDF’s ‘Understanding Stigma – Promoting Inclusive Attitudes and Practice’.

4. Delivering family-inclusive practice

Workforce Training in family inclusive practice is offered by Scottish Families Affected by Alcohol and Drugs (SFAD). This training offers staff a wide range of practical tools and techniques to involve families safely and effectively, as well as a deeper understanding of the benefits of family-inclusive practice. We will continue to encourage improved uptake of family-inclusive practice across the workforce.

5. Providing harm-reduction advice

It is imperative that the workforce is fully informed of harm-reduction approaches and confident to offer sound, evidence based advice and support. There is a challenge in ensuring that all professions who come into contact with people who use drugs and alcohol are trained to manage problem use and are equipped to be able to provide suitable help and care.

The Royal College of General Practitioners (RCGP) Scotland Certificate in the Management of Problem Drug Use is designed to support GPs, Pharmacists, prison healthcare staff, nurses, and third-sector workers.

The certificate gives staff the opportunity to develop their understanding of the importance of harm reduction in the management of drug use. By keeping staff informed and equipping them with the knowledge to give people affected by problem drug use the best help and care they deserve.

This course strives to provide enhanced knowledge amongst participants and also provides encouragement to develop new harm reduction initiatives in the primary care setting. Completion of the course equips clinicians with the skills to assess, support, and safely prescribe opiate substitution and other treatments for drug dependence with the aim of increasing access to treatment as quickly as possible.

The Scottish Government has ensured that RCGP’s Management of Problem Drug Use certificate has been funded to continue to deliver training until March 2026. Funding of approximately £420,000 will be provided over the next three years to ensure enhanced delivery of this programme.

Action 8

The Scottish Government will continue to support the delivery of workforce training across the five key areas identified in the ‘Changing Lives’ Report.

Timeline

Ongoing.

What will we do next?

Challenge

To ensure that the drugs and alcohol workforce is able to engage with high quality and accessible training provision.

Access to appropriate training is vital to ensuring that staff have the correct skills to support people achieve the best possible outcomes. It is also vital that staff are able to continue to develop within their roles and pursue their chosen career path.

Whilst there are already multiple training opportunities available, from various providers; these can often be difficult to access as they are hosted across multiple formats with differing access paths.

We also know that certain training opportunities are often regarded as being exclusive to certain sectors of the workforce as a result of the space in which they are provided or hosted. This can inhibit engagement by some working in alternative sectors.

Outcome

We recognise and welcome innovation underway, such as the Drugs Death Digital Hub^[41], hosted by the Royal College of Physicians of Edinburgh, which provides a range of useful educational resources for clinicians and allied health professionals. Other organisations also deliver a range of workforce learning and development courses, such as SDF through their range of in person training sessions and e-learning courses and SFAD through their Learning Hub.^[42] We would encourage those working in the sector to also engage with such resources.

The Scottish Government has been working with experts across the drugs and alcohol sector to develop an Online Pathway to communicate and signpost available training opportunities to the entire drugs and alcohol workforce. This Online Pathway will ensure greater accessibility to a range of training opportunities on a host of key subject matters, contributing to the delivery of a sustainable, skilled workforce.

Action 9

We will support the development of a single Online Pathway to communicate and signpost training opportunities to the entire drugs and alcohol workforce, regardless of sector.

Timeline

Initiated Tranche 1 (2023/24).

Challenge

We need to ensure that services are fully informed and empowered to support the mental health needs of people who use drugs and alcohol.

Prioritising the mental health of people who use services by integration of alcohol, drugs, mental health and social services is a running theme within the MAT Standards. MAT Standard 9 specifically highlights that

“All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery”^[43].

We know that too often people are denied access to mental health and substance use services due to their co-occurring conditions. There is a need to ensure all services are fully informed on the potential mental health needs of people who use drugs and alcohol.

Outcome

Our vision is for a joined-up healthcare system where people with co-occurring conditions get timely access to the help they need.

In June 2023, the Scottish Government published the ‘Mental Health and Wellbeing Strategy’, with a vision of a Scotland which is free from stigma and inequality and where everyone fulfils their right to achieve the best mental health and wellbeing possible.

The scope for the Strategy is wider, with an increasing focus on wellbeing and prevention and takes account of social factors and inequalities that might impact a person’s mental health and wellbeing. It recognises the many different factors that can influence mental health and wellbeing, and therefore the need for cross-policy, cross-system work.

The Strategy was followed by the publication of the ‘Mental Health and Wellbeing: Workforce Action Plan 2023-2025’^[44] and the ‘Mental Health and Wellbeing Strategy: Delivery Plan 2023- 2025’^[45] in November 2023. These outline how the Scottish Government and COSLA will progress a range of activities to address key workforce issues, and describes the work that the Scottish Government will undertake to improve mental health for everyone.

Action 10

We will continue to progress training opportunities, ensuring that services are well informed and fully empowered to support the mental health needs of people who use drugs and alcohol.

Timeline

Ongoing.

Action 11

As part of a wider programme of work to better integrate services, we will develop and implement new operational protocols which will detail how mental health and substance use services should work together to provide high quality care.

Timeline

Ongoing.

Challenge

To ensure that our workforce and services are trauma- informed and responsive.

The Scottish Government, in partnership with COSLA, NHS Education for Scotland (NES), the Improvement Service and the Resilience Learning Partnership are currently rolling out a National Trauma Training Programme (NTTP). This programme is based on the 2017 Knowledge and Skills Framework for Psychological Trauma developed by NES^[46] which sets out the level of knowledge and skills needed for staff, relevant to their role. The NTTP includes funding for a network of Transforming Psychological Trauma Implementation Co- ordinators who are based in health board areas and provide trauma expertise to organisations and Trauma Champions in their local area to support training, coaching, implementation and collaborations with people with lived experience of trauma.

Outcome

The Scottish Government will expand the existing TPTIC who will continue to support universal services as part of the NTTP. We will also recruit a National Lead specialist post to focus on developing support for trauma-informed substance use services, building on the learning from the trauma- informed substance use pathfinder work taken forward in Dumfries and Galloway and Orkney in 2022/23. This will ensure that both specialist and generic services that people who use drugs may encounter, are trained and equipped in trauma-informed practice to ensure appropriate responses and support is given.

Action 12

We will expand the existing TPTIC network and recruit a National Lead specialist post with experience in substance use and trauma informed practice.

Timeline

To be initiated in Tranche 1 (2023/24).

Challenge

To ensure that the drugs and alcohol workforce possesses a key set of competencies to appropriately support people who use drugs and alcohol.

A set of key skills and experiences are needed for anyone working to support people who use drugs and alcohol. These should be focused on embedding care, compassion, and empathy in service delivery. Training and improvement practice should be used to fully embed these competencies into practice.

Outcome

In order to ensure that the workforce possesses a key set of competencies, the Scottish Government will engage with an extensive range of relevant stakeholders to:

• Clarify the tiers and areas of the workforce to which these key competencies should apply;
• Identify and learn from existing practice and competencies across various sectors;
• Agree the competencies which each layer of the workforce should possess;
• Support organisations to embed these key competencies in job descriptions/ role profiles; and
• Raise awareness and promote these competencies.

Action 13

We will work with partners to support the development of competencies for workers who care for people who use drugs and alcohol.

Timeline

Initiated Tranche 1 (2023/24).

Challenge

To ensure that the workforce undertakes appropriate training to allow them to provide effective support to people who use drugs and alcohol.

The development of key competencies must be supported by appropriate training opportunities. There is a need to ensure that across the whole system, all those who engage with people who use drugs and alcohol understand this issue.

Outcome

The Scottish Government will build upon the development of key competencies to identify supporting workforce training. The Scottish Government will seek to ensure that access to training, identified as necessary, is made available. In order to deliver this outcome, the Scottish Government will work in collaboration with relevant stakeholders to:

• Clarify the tiers and areas of the workforce to which this training should apply;
• Identify and learn from best practice and available training within this area;
• Agree on what training opportunities should be undertaken by the workforce;
• Ensure that access to these training opportunities is available for all; and
• Increase engagement through improved awareness, promotion, and accessibility.

Action 14

We will work with partners to identify key training opportunities for the drugs and alcohol workforce.

Timeline

To be initiated in Tranche 1 (2023/24).

Challenge

The Scottish Government should provide support for the development of continuous career development for the workforce.

The workforce research compendium highlighted a lack of opportunities for career progression as a barrier to recruitment, consequently leading to workforce attrition.^[47] The ‘Changing Lives’ report outlined that steps should be taken to support the workforce with targeted continuous career development opportunities.^[48]

Outcome

The Scottish Government will work with key partners to establish defined career development opportunities. These will be based on, and follow the implementation of identified key competencies and supporting training.

Action 15

We will work with partners to support effective continuous career development for the drugs and alcohol workforce.

Timeline

To be initiated in Tranche 3 (2025/26).

Challenge

To commission the development of standards and guidance for all services who use peer support ensuring they are valued and appropriately paid.

People who use drugs and alcohol often perceive peer support as providing enhanced safety, thereby facilitating effective connection through shared life experiences. In addition, evidence tells us that training and education approaches involving people with lived and living experience help people in early recovery to become confident in their new identity. This can make recovery more visible. Supporting others can also form an important part of a worker’s personal recovery journey.

We know that the shared understanding and lived experience that peer workers and volunteers can bring to the workforce has immense value in terms of practical and motivational support. Relationships built on this trust are vital to ensuring people remain engaged with services. This is evident in the Navigator Service^[49], run by Medics against Violence with support from NHS partners, which helps to navigate individuals attending Emergency Departments away from chaotic lifestyles.

However, we know that often the role of peer worker is not appropriately valued. The ‘Changing Lives’ report also set out that peer support should be clearly defined.^[50]

Outcome

Peer workers have an important role to play in support services such as assertive outreach programmes. Standards and guidance should be developed to ensure they are valued for this, in line with the Scottish Government Fair Work principles.

The Scottish Government has been promoting Fair Work practices since 2019, through our Fair Work First policy.^[51] Employers in Scotland who are in receipt of public sector grants, contracts and other funding have been asked to adopt Fair Work First principles. In July 2023, further strengthening of this approach was introduced which requires employers in receipt of public sector grant funding to pay their workers at least the real Living Wage and provide appropriate channels for an effective voice. The Scottish Government believe that public sector funding should leverage wider societal benefits, such as high Fair Work standards.

We will seek to ensure that peer support workers are supported to develop and progress in their careers. We will seek to develop formalised pathways, as well as appropriate training, development, pay and career progression opportunities.

Action 16

As per Action 60 of the ‘Changing Lives’ report, we will support the development of standards and guidance for all services that use peer support, ensuring workers are appropriately valued and have career progression opportunities, in line with Fair Work principles.

Timeline

To be initiated in Tranche 3 (2025/26).