Drugs and alcohol workforce action plan 2023 to 2026

Nurture

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

The Nurture pillar requires us to look at how we support the workforce. Staff wellbeing is of utmost priority and consideration should be given to safe working, appropriate staffing levels and manageable workloads across the Health and Social Care sector.

Work needs to continue to ensure that appropriate support is offered across the system. We need to actively listen to staff, understanding pressures and any actions that can be taken to mitigate their impact.

Promoting positive, trauma-informed cultures leads to better wellbeing outcomes for both service users and the workforce. At the heart of any organisational culture there should be equality, diversity, and inclusion.

What needs to change within the drugs and alcohol sector?

Drugs and alcohol services are dealing with an ageing population of people whose needs are increasingly complex. Consequently, caseloads are not only growing larger but also more challenging. Increasing caseloads and high levels of sick absence often increase workforce pressures and make employment within the sector a less attractive proposition. All of these factors contribute to recruitment and retention challenges.

Steps should be taken to reduce caseloads for different parts of the system. Psychological support and wellbeing services should be provided to the workforce as standard.

Key Point: Current workforce challenges are a result of complex factors unfolding over a prolonged period of time. It is, therefore, not realistic, despite our best efforts and intentions, to expect that these can be immediately reversed through publication of this Action Plan. However, there are things that can be done to support staff now.

There is a clear need to address the stigma associated with working in drugs and alcohol services. Addressing this will help develop, enhance and sustain career pride. We will continue to work with employers to ensure that the workforce feel heard and included within their organisations.

The workforce engages with diverse communities and we aspire to facilitate one which is more diverse and reflective of the communities that it cares for.

What have we done so far?

Challenge

To support improved workplace mental health and wellbeing.

We know that those working in services are often under significant pressure. It is testament to their efforts that we are making progress on reducing deaths and improving lives. However, we have heard that working in this challenging context can, in some instances, lead to a form of ‘compassion fatigue’, which at times may manifest in stigmatising practice.

Whilst we acknowledge that manageable caseloads and appropriate staffing levels are key to workforce wellbeing; we also recognise that there are a range of existing resources which can support workforce wellbeing and we would encourage that these are fully utilised.

Outcome

We value every member of the workforce and their wellbeing remains a key priority. The Scottish Government has previously made £12m available to support this and introduced a National Wellbeing Hub^[55] and 24/7 helpline available to everyone working in health, social care and social work in Scotland.

We will continue to support staff mental health and wellbeing through national initiatives such as the National Wellbeing Hub, the National Wellbeing Helpline, Coaching for Wellbeing, confidential mental health treatment through the Workforce Specialist Service and funding to support the delivery of local psychological therapies and interventions.

The Scottish Government also support bespoke provision on offer for specific areas of the workforce, such as the Social Work Professional Support Service^[56] and would encourage staff to engage with resources such as this.

Action 21

The Scottish Government will continue to support positive workforce mental health and wellbeing through a range of national initiatives.

Timeline

Ongoing.

Challenge

To identify and share wellbeing good practice.

A subgroup of the Scottish Government’s WEDG focused on staff wellbeing. This group illustrated how the physical, mental and emotional wellbeing of those providing direct support to people who use drugs and alcohol were often negatively impacted. The factors impacting upon wellbeing generally replicated those challenges identified throughout this Action Plan, in addition to some specific operational challenges caused by systems not operating optimally. Whilst there are no ‘quick fixes’ to alleviate existing pressures, this subgroup was able to establish a baseline of existing good practice, through undertaking a scoping exercise in collaboration with ADPs. Some of the good practice identified as being delivered included:

• Management of caseload demands;
• Psychological support and wellbeing services;
• Coaching, supervision or reflective practice groups with a focus on staff wellbeing;
• Flexible working arrangements;
• Co-location of services to enhance joint working;
• Enhanced in-person working;
• NHS Scotland’s Supporting Staff in Distress & Crisis Information Sheet^[57];
• Provision of support and wellbeing resources to staff; and
• Staff recognitions schemes.

In recognition of such practice the annual ADP survey, designed to collect information on a range of aspects relating to the delivery of the National Mission, will now seek to understand which methods are being deployed to improve and support wellbeing within each area. This will allow us to better understand ongoing work and highlight best practice which local areas may adopt or develop.

Action 22

We will continue to monitor and highlight any ongoing practice which can promote workforce wellbeing.

Timeline

Ongoing.

What will we do next?

Challenge

To actively listen to staff, understanding pressures and any actions that can be taken to mitigate their impact.

Outcome

PHS are conducting an evaluation of the National Mission which will help the Scottish Government learn lessons around what is, or is not, working well. In order to help inform this evaluation PHS intends to also capture the views of frontline staff and understand their experiences of working in drugs and alcohol services. This will be done through an online staff survey. The results from the survey will be presented in the baseline evaluation report, anticipated to be published in Spring 2024.

Action 23

PHS will capture the views of the workforce through an online survey.

Timeline

Ongoing.

Outcome

The Self Care and Wellbeing: A Practical Guide for Health and Social Care^[58] course, developed jointly between the Royal College of Physicians of Edinburgh and the University of Edinburgh, is open and active. It is reported that many health professionals have found this resource helpful.

Action 24

We will encourage all to utilise existing resources which can support positive staff wellbeing.

Timeline

Ongoing.

Challenge

The need to address stigma experienced by those working in drugs and alcohol services.

Substantial evidence suggests that those working in drugs and alcohol services feel their work is often not afforded equal status to the work of their colleagues in other health or social care settings.^[59]

Outcome

Wider work to address the stigma experienced by those who use drugs and alcohol will deliver on the commitment to ensure dependency is regarded a health condition. The Scottish Government’s National Stigma Action Plan^[60] will support individuals and organisations to accept responsibility for their own behaviour and learning, and to take practical steps towards a stigma-free Scotland. As stigmatising attitudes towards people who use drugs and alcohol reduce, then it is anticipated that this will positively impact upon appreciation for the workforce.

Every member of the workforce should feel valued, respected, and included. Their value as a critical component of the wider Health and Social Care sector should be recognised. We will seek to ensure that those working in this sector are recognised as the front line health workers they are.

Action 25

We will utilise all opportunities to promote the vital lifesaving work undertaken by those working in the drugs and alcohol sector.

Timeline

Ongoing.

Challenge

To support organisations to provide effective care for employees with lived and living experience.

We know that some employers may be unsure about how best to support employees with lived and living experience of drugs and alcohol use. We also know that this is not always recognised as a health condition, often leading to stigmatising practice. The ‘Changing Lives’ report recommended that the Scottish Government should commission guidance on how employees in recovery can be supported.

Outcome

The Scottish Government is facilitating the development of guiding principles which will educate and inform employers on how they can provide optimal support for employees with lived and living experience of drugs and alcohol use. This is being developed in collaboration with a number of key third sector organisations and people who currently use, or have used drugs and alcohol.

The document will emphasise that recovery is not always a linear process and that setbacks are not uncommon. Support from an employer, rather than judgement and negative consequence, is required to enable the person to continue on their journey.

The guiding principles document will allow organisations to develop local guidance to address stigmatising practice and ensure that staff with lived, or living experience can flourish.

Action 26

We will publish a guiding principles document to inform organisations on how they can provide effective support to employees with lived and living experience.

Timeline

Initiated Tranche 1 (2023/24).

Challenge

To reduce caseloads for the drugs and alcohol workforce.

The workforce research compendium^[61] and 'Changing Lives’ report^[62] both make reference to the need to tackle burnout and staff wellbeing challenges; suggesting that there is a need to outline safe caseload limits as well as providing psychological support and workforce wellbeing services as standard, in order to manage trauma and work-related stress.

Outcome

Support for employee wellbeing is at the heart of all our workforce development efforts. The ‘Changing Lives’ report recommended that the Scottish Government should encourage the principles of the Health and Care (Staffing) (Scotland) Act 2019 to be applied to those areas of the workforce to whom it applies, in order to ensure safe and appropriate workloads.^[63]

Action 27

We will explore how the principles of the Health and Care (Staffing) (Scotland) Act 2019 should inform service design going forward.

Timeline

Initiated Tranche 2 (2024/25).