We recognise that all sectors in health and social care are under resource pressures. Drugs services, however, face specific challenges. These are highlighted in the evidence and the recent Scottish Government alcohol and drugs workforce survey (53).
We believe that working in drug and alcohol services can become an attractive and valued career option. The workforce could be supported, well-trained and well-resourced to provide quality services and support for those affected by problem drug use.
Specific pathways for entry, progression and continuous professional development within the sector should be in place to support all professionals to provide the highest standard of service and enhance their sense of value.
We will explore three key workforce issues for achieving this vision:
- recruiting people to work in the sector and creating pathways to attract the best people;
- developing and investing in the people who work or desire to work in the sector; and
- retaining those who already work in the sector.
4.7.1 Understanding workforce needs
The Scottish Government’s recently published workforce survey engaged with 206 organisations to produce an up-to-date picture of the workforce in the alcohol and drugs sector.
The report explored the level of vacancies in the sector and found an 8.8% vacancy rate. The rate varied across role type, service type and geographical areas. The report also explored caseloads, employee wellbeing and recruitment and retention challenges.
What needs to change
Information about existing vacancies in the system is valuable. It does not, however, provide a forecast of how the already high vacancy rate is likely to be exacerbated by new funding and initiatives under the National Mission.
This needs to be mapped to identify the real gap between what is present in the system now and what is needed to deliver the services people need.
The treatment target has set out an initial 10% increase in the number of people in OST services. This will increase over time to bring in other treatment types and will significantly increase the resourcing needs for services.
The MAT standards present the most significant shift in the sector in many years. They will need to be properly resourced to be fully implemented.
We recommend that a further rapid evidence review should be undertaken. This could be done as part of wider implementation of the service developments outlined in this report and the ambitions of the National Mission.
The review should:
- explore how the workforce may need to change to meet the priorities of the National Mission;
- identify the resources required to deliver this shift;
- pinpoint the shortfalls that will limit the ability to deliver quality services where they are needed; and
- support the development of the wider training programme offered to the workforce.
The review would enable the Scottish Government to take immediate action to support recruitment and retention in the sector. One such action that could be supported by the review would be to recommend that the Migration Advisory Committee incorporates the roles in the greatest shortage on the Shortage Occupation List. This would require detailed information on the specific roles in shortage and those that have proved most difficult to fill.
Action 125. The Scottish Government should build on the workforce survey by conducting a rapid review to determine the required workforce to deliver the service developments outlined in this report and the key commitments of the National Mission. The review should set out the resources needed to support an expanded workforce across the sector and undertake a training needs assessment.
4.7.2 Recruitment and retention
Recruiting new people to the sector will be critical to reducing vacancies, caseloads and pressure on the system. The National Mission asks for more from the workforce, so it is imperative that the workforce continues to expand to better support vulnerable people.
Recruiting more staff without steps to improve retention, however, will lead to further problems. Recruitment may then become a continuous cycle that drains more time from those already working in services.
What needs to change
We have made the case for broad culture change in the workforce to promote care, compassion and empathy. This should be evident in the way staff work to support people who use drugs and the way in which people who work in the sector are treated.
If we are to see an effective system of care, we must take steps to make the sector an attractive place to work. This means:
- tackling the stigma experienced by the workforce;
- delivering on the commitment of recent years to see drug dependency as a health condition in reality rather than just in rhetoric; and
- recognising the people who work in this sector as front-line health workers.
The workforce survey explored the caseloads of people working in services. Although it highlighted significant variability, it was clear that the current caseloads will inevitably lead to burnout. Steps should be taken as part of a wider move to regulate the drug and alcohol sector to outline safe caseload limits for different parts of the system.
Psychological support and wellbeing services should be provided to people who work in the sector as standard, to manage trauma and work-related stress.
Action 126. As part of the wider work to develop standards and guidance set out in previous actions, the Scottish Government should ensure the principles of the Health and Care (Staffing) (Scotland) Act 2019 are applied to this workforce to ensure safe and appropriate workloads for staff and that their wellbeing is supported.
The survey outlined the challenges of short-term funding. Lack of continuity in funding in the sector has significantly hampered retention of staff and has made jobs less attractive.
With finite resources, flexible solutions should be considered. We have seen good examples of clinicians working virtually to support local areas outside their ADP and groups of ADPs coming together as a region to fill resourcing needs and reduce pressures on the system. Funding will be covered later in this chapter.
4.7.3 Training and development
Training and development will be critical to having a skilled workforce to address the needs of this vulnerable group.
Developing staff has a dual benefit. It both enhances the quality of the workforce and improves retention through increased staff satisfaction and wellbeing.
People who work in the sector and those who use the services have sent an overarching message to us that a core set of skills and experience are needed for anyone working with people who use drugs. These should be focused on embedding care, compassion and empathy in service delivery.
What needs to change
Everyone who works in the sector or comes into contact with people who use drugs in their work should receive training on:
- taking a human rights-based approach;
- practising trauma-informed care;
- tackling stigma;
- delivering family-inclusive practice; and
- providing harm-reduction advice.
Improvement practice should be used to fully embed these competencies into practice. The workforce should feel empowered to implement and fully embrace changes that mainstream these principles.
Approaches that encourage training to be delivered to groups of professionals and people with lived and living experience have proved successful in reducing stigma and improving joint working.
The workforce should be well informed on key aspects of the treatment and recovery system in their area. This should include the NFO pathway and local referral processes.
The workforce survey highlighted challenges with development pathways and progression within the sector. Steps should be taken to support people who choose to work in alcohol and drugs services through a targeted continuous professional development offer.
The offer should include shadowing opportunities and peer-review supervision and support. It should also provide defined career progression opportunities. Widely accepted competencies and mandatory training requirements should be considered as part of the recruitment process.
Action 127. The Scottish Government and Healthcare Improvement Scotland should define key competencies and identify mandatory training for workers who support people who use drugs, and provide support for the development of continuous professional development in the service.
The sector has significant vacancies. The higher vacancy rates are being seen for clinical roles, which often require more extensive training. More targeted and accelerated career pathways therefore need to be developed.
At one level, there should be a commitment to increase access to college and university courses and develop new courses to fill the gaps outlined by the workforce survey. This should include specialised Higher National Certificate and postgraduate courses.
Wider reflection of addiction and dependency, however, needs to be present in general undergraduate studies that have a link to the sector. A clear and defined pathway into the sector that attracts people at an early stage should be in place, with options for further study.
Action 128. The Scottish Government should improve the availability of specialist dependency modules and courses in higher education, embedding this into undergraduate courses and establishing new post-graduate qualifications.
People with lived and living experience can be better involved in the workforce. As outlined by Dame Carol Black (6), too often they are exploited as volunteers when they can play a vital part in professional teams.
Peer workers have an important role in support services such as assertive outreach programmes. They should be valued for this.
Clients may prefer to receive support from peer workers and volunteers. They may perceive them as providing greater safety and being better suited to connecting and communicating with people who use drugs due to their shared life experiences.
In addition, evidence tells us that training and education approaches involving people with lived and living experience help people in early recovery to become confident in their new identity. This makes recovery more visible.
Formalised pathways must be developed for people with lived and living experience to work in the sector. Appropriate training and development, as well as pay and career progression opportunities, should form part of these pathways.
Action 129. The Scottish Government should support professions to develop specific pathways for people with lived and living experience to enter the workforce, ensuring they are appropriately paid and have career progression opportunities.
Adjusting the approach to the training offer can assist in filling vacancies in the sector and creating a skills pipeline. This could include alternatives to full-length courses, such as apprenticeships, which shorten timescales but also provide vital work experience.
Many such examples can be seen in, for example, shortened nursing courses or one-year fast-track courses where professionals commit to work with children or young people. This model could be replicated in the sector.
Action 130. The Scottish Government should develop targeted and accelerated pathways into the sector through, for example, apprenticeships and fast-track courses to address the high level of vacancies.
The Scottish Government may wish to consider the proposal made by Dame Carol Black for a “Centre for Addictions” to oversee workforce development.
4.7.4 Workforce action plan
A comprehensive and consistently reviewed action plan is needed to deliver on this critical investment in the workforce.
What needs to change
The action plan should take account of the distinct pressures of working in the sector and ensure that forward planning and funding allow for medium- to long-term planning on supporting the retention and development of the workforce.
It should also commit to implementing the key changes highlighted above.
Action 131. The Scottish Government should develop and rapidly implement a workforce action plan to: increase the number of qualified professionals in the sector; set standards, competencies and training requirements; and ensure the workforce is supported, well-trained and well-resourced.
4.7.5 Recovery in the workplace
As we have emphasised, meaningful activity and jobs are key factors in determining success in recovery. Many people, however, have highlighted the challenges people in recovery, especially those with previous criminal convictions, face in securing employment.
What needs to change
The Scottish Government should develop guidance on how workplaces can support employees in recovery. It should also commission training for managers on supporting these individuals.
The guidance should provide specialist advice and tools for occupational health on
the management of addiction as a health condition. It should emphasise that relapse is a common part of recovery, and that support (rather than judgement and consequences) is required to enable the person to continue on their recovery journey.
The guidance should also tackle exclusion from the workplace and improve access for people recovering from drug dependency into work.
Action 132. The Scottish Government should commission guidance on how employees in recovery can be supported.
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