The first comprehensive census of the field’s workforce provides a fascinating snapshot of a sector in transition.
Last month saw the publication of the first-ever national drug and alcohol treatment and recovery workforce census. Compiled by Health Education England (HEE) and the NHS Benchmarking Network (NHSBN), and based on impressive response rate of more than 80 per cent, the census covers the workforce for local authority-commissioned drug and alcohol services, local authority (LA) commissioning teams and LEROs in the year to 30 June 2022 – the first time the information has been gathered on anything like this scale.
The census report was commissioned as part of OHID and HEE’s drug and alcohol treatment and recovery workforce transformation programme in response to Dame Carol Black’s Independent review of drugs and the 2021 drug strategy, and will be used to help HEE work collaboratively with its partners to inform future planning and investment.
There were almost 11,500 ‘whole-time equivalent’ (WTE) treatment provider staff and just under 400 commissioning staff in 2022, the document states. Almost half of the entire treatment provider staff were drug and alcohol workers, with the other half including 23 per cent working in service management and admin, 10 per cent in peer support and service user development, and 9 per cent who were nurses.
Three quarters of drug and alcohol services staff were working in the voluntary sector, followed by 15 per cent working in the NHS and 4 per cent in LA-delivered treatment. Three per cent were working in the independent or private sector, with 2 per cent working for LEROs.
Almost two thirds of the treatment provider workforce were female, with 84 per cent of staff on permanent contracts and 69 per cent working full time. Twelve per cent were unpaid volunteers, meanwhile, and there were 684 WTE peer support workers across the workforce.
Ten per cent of staff overall reported a disability, although this was lower for the NHS and LA sectors at 7 and 5 per cent respectively. The median percentage of staff who consider themselves part of the LGBTQ+ community was 2 per cent.
A quarter of the overall workforce were on salary band 5 (£22k-31k) with another quarter on band 6 (£32-39k). In the voluntary and independent/private sectors, however, around 80 per cent of the workforce were on band 5 or below, compared to approximately 65 per cent for the NHS and 57 per cent for LA-delivered treatment. More than 90 per cent of the alcohol and drug workers staff group were on band 5 or lower. Forty per cent of voluntary sector staff had been in post for less than a year, compared to 37 per cent of staff overall and just 17 per cent of LA-delivered treatment staff.
A striking element of the census – and one that represents a watershed moment in the sector’s development – is the growing presence of LEROs in the field, making it clear that Carol Black’s foregrounding of the importance of lived experience has been taken on board.
Although the document points out that some findings related to LEROs should be interpreted with caution because of the comparatively lower number of submissions, 46 per cent of the LERO workforce were in peer support and service user development roles, compared to 9 per cent of the treatment providers workforce.
Service managers, meanwhile, accounted for 17 per cent compared to 23 per cent for treatment providers. Seventeen per cent of the LERO workforce were volunteering or in unpaid roles, while almost 80 per cent were on band 4 or below (up to £26k). This compares with 12 per cent of treatment provider staff being unpaid or volunteers. At 34 per cent, a similar proportion of the LERO workforce had been in post for a year or less when compared to treatment providers.
Just over 40 per cent of the LERO workforce were on permanent contracts, and the same for fixed, while 17 per cent were on temporary contracts, whereas almost 85 per cent of staff at treatment providers were on permanent contracts. Just under 60 per cent of LERO staff worked full time, meanwhile, compared almost 70 per cent in treatment providers.
Across the workforce as a whole, the percentage of staff from a Black/Black British ethnic minority background was between 5 and 9 per cent, compared to 4 per cent of the working-age population in England as a whole. However, the percentage who were Asian/Asian British was between 4 and 8 per cent, compared to 9 per cent of the working age general population. The sector’s staff meanwhile, is generally older than the working age population as a whole with higher percentages of staff in the 40-49 and 50-59 age bands.
The findings of the report have informed the soon-to-be-published Drugs and alcohol treatment and recovery workforce strategic framework, says HEE, and will also support the forthcoming comprehensive workforce strategic implementation plan.
Drug and alcohol treatment and recovery services: national workforce census at www.hee.nhs.uk
Drilling into the detail – The Data
There were 535 data submissions – 347 were from treatment providers, 165 from commissioners and 23 from LEROs. Most provider submissions were from voluntary organisations (78 per cent) followed by the NHS (18 per cent), and the independent/private sector (4 per cent). Submissions from LA commissioners included those reporting activity for commissioning staff only (72 per cent), those including activity for treatment staff employed by the LA (19 per cent) and those that sent submissions including both commissioning and treatment staff (9 per cent). By service type, most submissions were for community treatment and recovery services (69 per cent) followed by young people’s services (20 per cent), residential rehab (8 per cent) and inpatient detox (4 per cent).
Participation rates per sector were 89 per cent for local authorities, 81 per cent for treatment providers and 60 per cent for LEROs. ‘The percentage of LEROs who participated was based on a partial list and although this grew over the course of the project, remained incomplete,’ says the document, meaning the information should be viewed as ‘indicative rather than definitive’. The list of treatment providers also changed – expanding from lead providers submitting to NDTMS to also include submissions from sub-contracted services for a more comprehensive view.
The census received submissions from all sectors for all seven HEE regions – East of England, London, Midlands, North East and Yorkshire, North West, South East and South West. Most independent/private sector submissions were from the North West, and most submissions for LEROs were from London and the Midlands, although there was at least one for each region.
Workforce transformation is a key function of HEE, to support the development of a workforce that’s responsive to change. ‘Workforce transformation is a process, driven by improving the way we recruit, retain, deploy, develop and continue to support the healthcare workforce, to meet the growing and changing needs of local populations – ensuring high quality care for the patients of today and the future,’ HEE states. ‘COVID19 in particular has shown us how imperative it is to have a skilled, flexible and resilient workforce, able to adapt quickly in times of crisis to deliver the best healthcare possible in a way that works for all.’