Alcohol and drugs workforce: mixed-methods research compendium

2. Recruitment

The data showed that recruitment was a major issue for the drugs and alcohol workforce. Evidence from the survey of services showed a sector-wide vacancy rate^[3] of 8.8% as of 1 November 2021. This is higher than vacancy rates amongst allied health and medical professions overall at the nearest census date (30 September 2021), which were 7.6% and 7.0% respectively^[4]. Although clinical positions had higher vacancy rates on average than non-clinical positions, 13 of the 29 individual roles queried in the survey (44.8%) reported vacancy rates exceeding 10%. These results suggest that vacancies are problematic across a wide variety of role and organisation types.

The reasons for these recruitment issues are several. First, there does not exist any formalised pathways into careers in drug and alcohol services. A comprehensive evaluation of delivery in health and social care subjects in college settings suggests that many hundreds of people are completing courses every academic year which might prepare them for careers in the drug and alcohol workforce. These range from nursing, psychology and pharmacology, to courses relevant to non-clinical yet still essential roles in advocacy work, social work, counselling and health/social care management. However, partner agencies have confirmed that there is not a single college course currently offered which includes 'drugs', 'alcohol', 'addiction' or 'substance' in the course title. Furthermore there is not any public database of course content (such as module names or syllabi) which might offer insights into the relevance of degree programmes to work in drugs and alcohol services.

By contrast, there are dedicated consortia at universities actively progressing empirical research in this space. Moreover several higher education institutions offer interdisciplinary, postgraduate-level degree programmes specifically oriented around substance use. However, the focus of these courses is on training people for roles in academia and/or research rather than frontline services. It is therefore difficult to draw conclusions about trends in the 'pipeline' of the potential drug and alcohol workforce.

In addition, a major theme emerging from the qualitative survey responses concerned the general precariousness of secure funding for drug and alcohol posts as well as programmes. This is consistent with the shortfalls facing the wider health and social care sector. Many programmes are funded on a short-term basis, which not only complicates strategic planning efforts, but also often results in low salaries and/or fixed term roles. These factors were reported as a serious deterrent to potential applicants, and services of all types – NHS, health and social care partnerships, third sector services and others – flagged this as an issue.

There was also substantial evidence from the literature review and survey suggesting that negative perceptions of employment in drug and alcohol services are proving detrimental to recruitment efforts for this workforce. As one survey respondent put it, "…Drug and alcohol services are marginalised and often stigmatised as our service users are, the work that we do, the care and support that we provide is not always understood or appreciated by wider health and social care". Respondents specifically highlighted how challenging an environment frontline drug and alcohol services can be to work in, and how burnout was affecting word-of-mouth promotion of this sector to prospective applicants.

The lack of value was also reflected in the types of qualifications available; many people in non-clinical roles undertake qualifications which are not valued by other professions in the same way as a traditional degree, for example Scottish Vocational Qualifications^[5]. Greater appreciation for the specialist professional skills required to work in this sector, for example through the recognition of qualifications and training, would confer a level of value that would, in turn, empower drug and alcohol workers to provide treatment and services more effectively.

Finally, survey respondents highlighted that in some cases, the unique perspectives of people with lived experience are not being fully taken advantage of. The skills and experience these people have is often not reflected in the types of roles available to them because they usually lack the necessary qualifications and/or formal work experience. While there are some excellent examples of programmes supporting people with lived experience to enter gainful employment (such as Scottish Drugs Forum's Addiction Worker Training Project^[6]), these remain few in number. People with lived experience have the potential to bring an additional quality and skillset to this challenging work, so developing more opportunities for them to gain the requisite certifications and move into paid roles has the potential to enhance this sector.

Further, those with lived experience were roundly considered a valuable part of the drug and alcohol workforce. An example offered by a survey respondent from the NHS is demonstrative:

"Prior to the COVID-19 we had volunteers with lived experience who worked alongside the ALN's via third sector organisation Alcohol and Drugs Action. This involved meeting patients in hospital prior to discharge with the aim of engaging them in the recovery community and ADA gorups[sic] and activities. Unfortunately this work was suspended due to hospital visiting restrictions during the pandemic. We are looking at starting this work again as it was successful."

The important role that people with lived experience play in delivering services – along with other frontline staff – ought to be recognised and developed further.