National Workforce Census
In the second part of her Review of Drugs, Dame Carol Black was very clear that revitalising our drug and alcohol treatment sector was dependent on recruiting many more skilled and committed staff. As usual, she did not mince her words:
“The drug treatment and recovery workforce has deteriorated significantly in quantity, quality and morale in recent years, due to excessive caseloads, decreased training and lack of clinical supervision. A recent workforce survey showed that drug workers had caseloads of between 50 and 80, sometimes rising as high as 100 people. Good practice suggests a caseload of 40 or less, depending on complexity of need. Such high caseloads reduce the quality of care provided and the effectiveness of treatment. Focus should be on providing high-quality personalised care, rather than paperwork.”
Now that the Government has started to invest in the drug treatment sector again, the issue of recruitment is key to the task of rebuilding. The just published National Workforce Census of Drug & Alcohol Treatment and Recovery Services gives a good picture of the work that needs to be done.
The main findings from the census are set out below and are helpfully summarised in the infographic I have reproduced further down this blog post. The main findings relating to staff working in drug and alcohol treatment were:
- Across all sectors 11,851 whole time equivalent (WTE) staff were reported, 11,269 WTE (95%) for the treatment provider workforce , 398 WTE (3%) commissioning staff and 184 WTE (2%) lived experience and recovery organisation (LERO) staff.
- The voluntary sector accounted for almost three quarters of the drug and alcohol workforce
- (74%) followed by the NHS (15%), LA delivered treatment staff (4%), independent /private sector (3%), LA commissioning staff (3% 3%) and LEROs (2%).
- Regionally, whole time equivalent per 1000 treatment number ranged from 34 WTE to 42 WTE. (The report says that many factors may influence this metric but clearly local commissioners will want to understand where they sit in relation to the benchmark and why).
- The profile of the workforce by job role shows just less than half of the treatment provider workforce is made up of alcohol and drug workers, followed by service management and administration (23%), peer support and service user development staff (including support workers) (10%), and nurses (9%).
- Across all sectors 684 WTE peer support workers were reported.
The treatment provider data presented below includes data from the voluntary sector, the NHS, the independent/private sector and also activity relating to treatment provision delivered by local authorities (LA delivered treatment).
- The voluntary sector makes up 78% of the treatment provider workforce (8,768 WTE), with the NHS the second largest sector at 16%16%(1786 WTE).
- The independent/private sector and LA delivered treatment sector account for a smaller proportion of the workforce at 3% (299 WTE) and 4% (417 WTE), respectively.
- Alcohol and drug workers make up the largest proportion of the workforce at 48%.
- Vacancy rates ranged from 11% (voluntary sector) to 25% (LA delivered treatment sector) for all staff.
- For the largest staff group, alcohol and drug workers, vacancy rates ranged from 13% (voluntary and independent/private sectors) to 21% (NHS).
- For alcohol and drug workers (the largest staff group) the turnover rates ranged from 13% (460 leavers) in the voluntary sector to 23% (52 leavers) in the NHS.
Lived experience recovery organisations (LEROs) returned 23 submissions for just 18 local authority areas, meaning that the findings should be interpreted with caution. These 23 LEROs reported 184 WTE across six workforce groups with peer support and service user development roles the largest at 84 WTE (46%).
A staggering one in eight (12%) of the treatment provider workforce are unpaid, comprising volunteers and peer mentors.
I have only included the headline findings in this blog post but commissioners and people involved in workforce planning and recruitment will find the census invaluable. It also contains detailed findings about the ethnic composition of the substance misuse workforce as well as sickness and turnover rates.