Dame Carol Black’s report emphasises the importance of workforce development with several recommendations to address workers that are “on their knees”. Rob Calder discusses why workforce development should be an expectation, not an optional extra.
Perhaps one of the most striking parts of the Dame Carol Black report (part 2) is its use of the word ‘demoralised’ to describe the workforce: “The workforce is depleted, especially of professionally qualified people, and demoralised”. It will come as no surprise to many that the addictions workforce is demoralised, but seeing it written in a report of this profile brought it home.
“Delivering effective and evidence-based treatments can improve treatment outcomes, it can save lives. Are these not important enough outcomes?”
There are several recommendations in the report for addressing this issue
The first is a recommendation that Health Education England should develop a workforce strategy. This is a big task. It will involve employing new recovery workers. It will involve employing and training specialist nurses, psychologists and psychiatrists. It will involve encouraging people back into a field that they have left. The report talks of setting training requirements for drug workers and peer recovery workers and of developing National Occupational Standards…NOS, the acronym rings a bell. Perhaps there’s something in DANOS that can be dusted off and updated?
The second recommendation is that the Academy of Medical Royal Colleges should develop a ‘Centre for Addictions’ for people working in substance misuse services. This sounds very promising. In a recent webinar, however, Dame Carol Black commented that this would be a place where workers can access training and treatment resources. For this to succeed where similar initiatives have failed, these kinds of resources need to be part of a requirement, rather than something that can be accessed. If you have the inclination. If you have the time. If you know where to look.
It is encouraging that the report itself talks of HEE setting ‘competency and training requirements’; however, the potential benefits depend on exactly what will be required and what will be optional.
Time for training
Where access to training is optional, keen people will do it, but the disenfranchised (demotivated? demoralised?) might not; and, to address the current situation, it is the demoralised and demotivated that are most in need of this kind of support.
“Training and development are always a lower priority than speaking to someone who has just turned up in crisis. To be effective, both money and time for training need to be ringfenced.”
Most organisations and managers want staff to attend as much training as possible, it’s just that there are so many other priorities. A whole day’s training is a project with a staff member down. Even with the convenience of online learning, training in evidence-based treatments is often a lower priority than annual data protection training, health and safety training and safeguarding training. Training of any kind is a lower priority than speaking to someone who has just turned up and who needs support. To be effective, money and time for training both need to be ring-fenced.
What training is required and what is optional?
If you think back to DANOS and the NVQ in Health and Social Care. Both these workforce initiatives had promise as workforce training requirements, but both fizzled out in the end. Most people agreed that all staff should have an NVQ (I myself am a proud owner of one), it’s just that, in the end, commissioners didn’t require it, CQC didn’t require it, most provider organisations didn’t require it, PHE didn’t require it. So, when things got tight, it didn’t make much sense to spend time and money on an NVQ that was costly and not required.
It has become an expectation that addiction treatment services follow regulations that keep service users safe. Issues around health and safety and safeguarding are important and are mandated. Training in evidence-based treatments is not mandated in the same way, raising questions about the priority given to such training. Delivering evidence-based treatments improves treatment outcomes, it saves lives. Are these outcomes not enough of a priority?
There are many barriers to accessing training, of which provision is just one. In order for any Training Centre to become well used by the substance use workforce, barriers around attitudes, money, time, priorities, regulation and requirements should also be addressed.
The addictions workforce does an amazing and incredibly difficult job. To do that job well, they need regular and substantive training. If that training is optional, the message is that they can attend if they like, but that treatment skills are not really essential to the job. It can imply that the core part of their job isn’t really that important. And that kind of message is… well, demoralising.
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