Alcohol and drugs workforce: mixed-methods research compendium

4. Service design

The drug and alcohol sector also faces challenges in the way services are designed. Drug and alcohol services are commissioned at a local level by the ADPs across Scotland. While this enables services to respond to local needs, it also means that there is wide geographical variation in the way services are designed and what services are available. Certain services are not always available locally, for example residential rehabilitation, or are not available on a full-time basis. In some areas there are not always appropriate services available to which service users can be moved, to the detriment of their wellbeing and recovery. It also has negative consequences on the capacity of services themselves. Services are unable to flow people through systems while they continue receiving new referrals – an issue that is particularly acute in rural areas – and so become increasingly stretched.

Some services operating with higher caseloads reported that this results in systematic challenges as staff have less time to undertake tasks such as recording case notes (a legal requirement for many roles and services). In these circumstances staff may focus on documenting information about issues posing the highest risk, such as child protection, at the expense of factors such as housing or employment. This means staff do not develop a holistic perspective of people's lives, and opportunities for meaningful intervention are lost.

There have also been reductions to funding for the sector since 2016. While funding levels have increased in recent years, particularly with the introduction of the National Mission in 2021^[10], this legacy led to some services closing or reducing their capacity. The constrained spending environment in which services are operating emerged from the both the literature and the survey responses as a clear challenge. As noted above this also has negative consequences for recruitment and retention in the sector.

Issues with staff availability, training and skills hamper the ability to design services, with respect to both capacity and the roles of the different professions. One important factor arising from the literature is the evolution of the role pharmacists play with people who use drugs. Pharmacists have reported engaging in additional training in substance misuse which has built the skills base of this profession. This has not only increased their roles and responsibilities over the past 20 years, but also their confidence in working with this service user group. There is potential for this to be replicated across other professional groups who are not necessarily employed in specialist drug and alcohol services, but who do work with people who use drugs. If more of these professionals – for example GPs, social workers, housing officers, etc – became more skilled and confident in working with people who use drugs and alcohol, this could potentially alleviate some of the pressure on specialist services.

Finally, the impact of COVID has led to a greater degree of partnership working in some areas, and to services being more flexible in the ways they operate. For example, some organisations reported introducing telephone or online services to help users. These changes could inform service design and delivery going forward.