Alcohol and drugs workforce: mixed-methods research compendium

5. Considerations for future work

The drugs and alcohol workforce plays a crucial role delivering specialist health and social care services in Scotland. However, the data collated during this project shows that staff in frontline roles – in addition to already working in challenging environments – regularly face operational and strategic obstacles that impact their ability to deliver for their service users. Moreover, workforce planning efforts must align with the National Workforce Strategy for Health and Social care in Scotland^[11]. Based on this evidence, we therefore propose the following points for consideration.

First, there needs to be improved data capture for this population. NES maintains workforce statistics for every professional category in the NHS, however there is not a tick-box to specifically indicate drug and alcohol workers. This would be a valuable means of collecting trend information on the scope and scale of this workforce, and therefore how and where to start tailoring interventions.

A more long-term aspiration would be to leverage the skills pipeline more effectively. Although the data suggested that there has been increasing CPD uptake in the last few years, survey respondents highlighted the need for more specialised training options. In addition, course offerings in further and higher education settings – especially in colleges – need to be further developed to meet workforce needs. On the university side, the Higher Education Statistics Authority introduced a bespoke 'drugs and alcohol studies' category from academic year 2019-20. This will provide insights important on students completing relevant qualifications at the university level.

Further, consideration must be given to the challenges of excess workloads and burnout within the sector. This arose time and again across different areas of this research project, and coheres with issues facing wider health and social care. However, the capacity problems highlighted here must be considered alongside the job insecurity that some elements of the workforce consistently face.

There is also a pervasive stigma associated with working in this sector. This is partly the result of a general lack of understanding around what working in frontline services entails. Perhaps more importantly is the perception that working in drug and alcohol settings is somehow less valuable or less important compared to other roles in health and social care. Improved public awareness would not only empower those already working in services, but might also raise the profile of this workforce and thus generate more interest from prospective applicants.

In addition, the value of people with lived experience in delivering frontline services cannot be overstated. Survey respondents and reference group participants alike highlighted that this cohort is a vital part of the workforce, but can sometimes be overlooked or under-appreciated. Going forward, more needs to be done to ensure that people with lived experience have access to appropriate training, and play a more active role in designing services.

Finally the myriad challenges associated with the COVID-19 pandemic and lockdowns have had a lasting impact on drug and alcohol services, in terms of both recruitment and service delivery. However, it also presented opportunities. For example, several services outlined how the pandemic prompted increased inter-organisational collaboration and communication. Because COVID was not the focus of this project, more research is required to collect data on how the pandemic has affected the ability of frontline staff to deliver drug and alcohol services. This could involve examining fluctuations in employment and caseloads, the implications of moving to increased tele-health delivery or changes in prescribing practices.

In any case, the demands on services will no doubt increase as restrictions continue to be relaxed, and services continue working towards embedding Medically Assisted Treatment (MAT) Standards^[12]. Scottish Government has also announced an Opioid Substitution Therapy treatment target, which will be expanded to cover all drugs and alcohol by April 2024^[13]. The data and evidence outlined here could play a crucial role in informing governance arrangements and strategic thinking around current approaches to recruitment, retention and service design for the drugs and alcohol sector, which will help empower the workforce to more effectively deliver on behalf of service users.