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Staffing and ‘siloed’ working a barrier to care of drug users - review

Posted on 21 June 2022

A review of the Government’s £80 million investment in treatment for drug users has shown that “non-existent staff and fragmented clinical services” were a major barrier to implementing improved practices for some of the most marginalised patients.

Agencies working in silos, managing their own budgets in isolation, and staffing was a major barrier to support for drug users

The societal costs of drug misuse are £20 billion each year, and yet only £650 million was spent on drug treatment between 2020 and 2021 

Following the publication of Dame Carol Black’s Independent Review of Drugs in England, the Government granted £80 million of one-year funding to improve treatments for drug users, £55 million of which was set aside to support local authorities in improving treatment for opiate users and within the criminal justice system in particular.” 

Limiting

Investigating the impact of this funding, researchers at the University of York found that the one-year funding period severely limited the ability for commissioners and managers to plan ahead and recruit and train new staff to revitalise this area of care. 

The 2012 Health and Social Care Act saw significant and sustained budget cuts and reduced incentives for partnership work, resulting in staff exits and the loss of shared resources to support patients with complex needs.   

Researchers learnt that the loss of skilled professionals and the fragmentation of services, meant the ability to join the dots between criminal justice, drugs treatment, housing, employment and social care, was lost and health professionals were therefore unable to develop effective rehabilitation treatment programmes.  

Fixed contracts

Struggles to recruit staff with any relevant experience within a short time-frame resulted in local authorities competing in the same limited recruitment pool, or seconding staff from other local services, leaving staffing gaps elsewhere. 

Dr Geoff Page, from the University of York’s Department of Social Policy and Social Work, said: “The last decade has really seen all of the features that make drug treatment an appealing workplace disappear. The latest investment to be spent in a one-year cycle, meant that jobs to tempt people back into this area had to be fixed at one-year contracts, which for many is not an attractive offer. 

“It is an area of work that over the years has been deskilled and deprofessionalised, adding to the problem of how you recruit people that have relevant experience and who can handle complex work and carry the responsibility of the health of some of the most vulnerable people in their community.” 

Retaining services

The study showed that there were some positive impacts from the Government investment, such as a renewed focus on harm and crime reduction, and new beds and facilities for drug detoxification. The biggest concern, however, for health authorities were retaining services once the year-investment window had closed. Few thought they would be able to maintain new services beyond the initial year, without assurances of additional funding. 

Researchers recommended that to counter these concerns long-term guaranteed funding must be implemented to work towards clearly defined goals that can be measured in a more realistic timeframe.  This should help commissioners and managers to plan long-term upskilling of a workforce, to retain any services built over the initial year and help tempt more staff into jobs. 

Agencies working in silos, managing their own budgets in isolation, was a major barrier to success in this area, and therefore researchers suggest that a reconsideration of shared budgets and collaborative working across multi-agency teams must be the way forward. 

National skills

Dr Page said: “One of our core recommendations is establishing national skills standards to professionalise the job, and give the profession a status that will help recruitment and retention of staff, something that is currently completely absent from all calls to support this complex area.” 

The research is funded by the NIHR Policy Research Programme, through the Partnership for Responsive Policy Analysis and Research Programme (PREPARE), a collaboration between the University of York and the King’s Fund for fast-response analysis to inform Department of Health and Social Care’s policy development.  

The research is published on the PREPARE website; to view click here.

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