Alcohol and drugs workforce: mixed-methods research compendium

3. Retention

In addition to the recruitment matters outlined above, the data emerging from this study also identified serious issues with retaining staff already in the workforce.

An important element of this is the lack of upward mobility for staff working in drug and alcohol services to progress their career. For example, the survey data showed that the third lowest vacancy rates in the sector were for service managers at 2.1%. The qualitative data also confirmed that progression to higher levels typically happened only when someone left their post. This suggests there is a pinch point for those seeking to proceed to senior roles with a managerial/leadership component, which can lead to operational staff considering employment out with drug and alcohol services.

Closely related to progression is development. Put simply, there are few opportunities for drug and alcohol workers to undertake CPD and upskilling. Granted, the data suggested that enrollments on CPD courses actually increased across a variety of substance abuse topic areas^[7] over the last few years, and this was the case for multiple training providers. Some of this may be due to the wholesale migration of training to online mediums. Nevertheless, there is a dearth of formal qualification routes and specialised courses for non-clinical staff (as highlighted above).

The lack of funding to enroll on courses is also problematic, especially for a sector that is already cash-strapped. One survey respondent called for "…Increase[d] bursaries to allow more staff to do post graduate study to retain them not just SVQ health and Social care but specialist courses… around addiction and harm reduction different models". Funding shortfalls also have implications for staff already in the workforce. For example, a reference group participant noted that upskilling band 3 and 4 nursing staff via a higher national certificate scheme was "…unattractive at present" because it requires nurses to take a pay cut while they retrain. Finally, respondents highlighted how geography can be a preventative factor for those interested in professional development. However the implications of online delivery for CPD uptake remains to be seen.

Another major issue with retention concerns increasing workloads impacting staff wellbeing. Services are dealing with an ageing population of drug users whose needs are increasingly complex^[8], and consequently caseloads are not only growing larger but more challenging.

Respondents in the survey highlighted how increasing workloads were leading to mental and physical health issues, attrition and burnout amongst frontline workers. Over 10% of respondents discussed how these factors impacted staff sickness, which itself has a cascading effect: overworked employees become progressively more stressed, which leads to them taking more sick days, which then leads to other staff having to manage their caseloads, which leads to stress amongst those employees, which results in more sick days, and so on. As one respondent noted:

"At one point in summer 2021 the team only had one registered nurse and team lead covering caseload for a team of 8. Team lead is not supposed yo[sic] have a casleoas[sic]. Most of their work was not completed ans[sic] they are also supposed to support another team tooo[sic].. This then lead to burnout of one team members[sic]. The team has always been sitting with vacancies or long term sick since may[sic] 2019 with between 2-6 staff short. Team are also having to heavilly[sic] support 2 band 5 staff as they are both newly qualified… It is very stressful at times"

Over the six month period from 1 May to 1 November 2021, survey respondents reported a median total of 34 sick days taken per service^[9]. Multiple linear regression of this data showed a significant association between caseloads and sick days. When controlling for certain independent variables, a one unit increase in the average caseload per WTE employee increased the number of sick days taken by 5%. This finding suggests that the employee-service user interface is a crucial indicator of staff wellbeing, and has important implications for staff given how volatile caseloads and referrals to drug and alcohol services can be.