Story updated 14 December 2021
The government’s drugs strategy appears to have “completely overlooked” the role of social work in supporting individuals and familied affected by substance use.
That was the warning from Sarah Galvani, professor of social research and substance use at Manchester Metropolitan University, following the publication of the strategy this week.
Despite the strategy taking a “whole systems approach” to reducing drugs use and promoting recovery, it makes no specific references to the role of social care.
By contrast, there are significant sections, backed by investment, on the role of housing and employment support, in promoting recovery, alongside a strong focus on expanding specialist drugs services, in prisons and the community.
Galvani, whose research focuses on substance use and social work, said: “Social work and social care services appear to have been completely overlooked in terms of their role in supporting individuals and their families where there is substance use.
“The focus appears to be primarily on the specialist workforce with little understanding that social care services, be they social work or social care, work with people using substances who never reach services or who drop out or whose lives and families are negatively impacted by their use.”
She welcomed the whole systems approach – taken from Dame Carol Black’s review of drugs services that provides the basis for the strategy – but Galvani said the absence of focus on social care betrayed a lack of understanding of its role within government.
“Substance use can become an adult and child safeguarding issue as we know and social workers work daily with people using substances who are experiencing problems,” she added.
“The wider social work and social care workforce need training in substance use in order to feed in to the specialist services appropriately and to ‘hold’ those who do not want to receive specialist support. It’s not simply a case of referring on.”
Lack of clarity on social work posts
It is also not clear how far specialist social workers are included in the government’s plan to “rebuild” the “depleted” drug and alcohol workforce, as part of the strategy.
It includes plans to increase the number of medical, mental health and other professionals by 800 and drug, alcohol and criminal justice staff by 950 over the next three years.
However, while the strategy references doctors, nurses, psychiatrists, psychologists and registered health professionals generally by name as being among the first of these groups, it does not mention social workers.
This was despite the fact that Black recommended the creation of 52 new social worker posts over the next three years, and 78 over the next five.
‘Significant deterioration’ in workforce
In the second report of her review, published in July, Black said there had been a “significant deterioration” in the quantity, quality and morale of the drugs workforce due to service cuts in recent years, leading to high caseloads.
She added: “The only effective treatments for people dependent on non-opioid drugs are psychosocial interventions including cognitive behavioural therapy, yet people with professional skills in these areas are in very short supply. Dedicated social work teams for drugs and alcohol are also disappearing.”
The government accepted Black’s recommendation to rebuild the “depleted” drugs workforce.
“We need to rebuild the sector’s health professional workforce (including psychiatrists, doctors, nurses and psychologists) and improve the level of skill and training among drug workers and peer recovery workers, so that they are all well equipped to deliver the psychosocial and health interventions that drug users in treatment require to succeed,” the strategy says.
It adds that staff would have lower caseloads and the skills to deliver “evidence-based psychological interventions” that would improve recovery rates, particularly for users of non-opiate drugs, such as cocaine, and recently initiated heroin users.
The government’s figures appear to fall short overall of Black’s recommended expansion in the number of professionals over the next three years (800, as opposed to 1,113).
It said it would develop a strategy with Health Education England to expand the workforce and “define and improve the training and skills of all sections of the drug treatment workforce, including registered health professionals, drug and alcohol workers, and peer supporters”. This will include consideration of the role that can be played by social workers, though it is not clear how far this will include extra roles as recommended by Black.
Need for ‘serious effort’ to recruit social workers
In response, the British Association of Social Workers (BASW) criticised the lack of detail on expanding social worker numbers in the strategy.
A spokesperson said: “Professor Dame Carol Black’s independent review into misuse of illegal drugs recommended an increase to the number of professionally qualified drug treatment staff, including social workers, but the Prime Minister’s new drugs strategy fails to mention how they intend to implement this.
“The strategy also falsely places an emphasis on alcohol and drug use as criminal activity and a ‘war that can be won’ instead of recognising wider issues of addressing economic and social injustices that play a direct link to such activity.
“Social workers are on the front line of health and social care, with substance abuse impacting the lives of many people who receive social work services. Any proposals to tackle drug misuse will not be enough if there is not a serious effort and strategy to recruit more social workers in drug services.”
‘Safeguarding professionals key’
Provider Turning Point backed the workforce plans and stressed the importance of social workers’ roles.
“We are really supportive of the proposals in the strategy around the expansion and professionalisation of the substance misuse workforce,” said national director of operations Clare Taylor. “Increased numbers of specialists, along with the introduction of new professional standards will help improve the quality of services.
“There is an important role for professionals with a robust safeguarding qualification, such as social workers, in drug and alcohol services. There is clearly work to do on the detail – and hopefully there will be the opportunity for provider organisations to work with government on this.”
A Department of Health and Social Care spokesperson said: “We’re investing a record £780 million to improve access to treatment and increasing the capacity of services as part of our bold 10-year drug strategy.
“This will allow us to develop a world-leading treatment system, including expanding the workforce by over 1,500 staff to ensure people have more support and help to overcome their addiction.”
As part of this, the government said it would continue this year’s £80m boost to local authority-commissioned drugs services over each of the next three years, which is on top of the existing £670m-a-year public health grant, designed for the same purpose.
The strategy says councils should focus this on reducing drug-related deaths, bringing more offenders into treatment, and expanding inpatient detox services and provision for those with complex needs.
The government will also provide an extra £293m from 2022-25 for councils to invest in drug and alcohol services. This will go first to the 50 areas with the highest needs, based on drug-related deaths, and levels of use and crime, before being rolled out to the rest of the country.
The government said it would set grant conditions to ensure this money was spent on evidence-based treatments, potentially with a clawback mechanism if money was not used as intended by councils.
It said it would expect the funding to cover interventions such as needle and syringe programmes, medicines to reduce harm and support detoxification and psychosocial programmes “to support people to understand their addiction, make changes and develop coping strategies”.
‘Ignored and marginalised for too long’
Treatment provider Change Grow Live strongly welcomed the strategy, including its plans for the workforce.
“The success of this strategy depends in large part on the people who deliver treatment and recovery services, from psychiatrists to caseworkers and volunteers, so we welcome new funding to attract people to jobs in the sector, to support better training for them, and to keep caseloads manageable,” said chief executive Mark Moody.
He added: “We also back the ambition to see the full range of evidence-based harm reduction and treatment services available for all those that need them in every community, starting with the most deprived areas, which are disproportionately affected by drug use.”
However, Moody said, “people who use drugs have been ignored and marginalised for too long by policymakers”, meaning the strategy was “just the start”.
Deaths at highest level since records began
The strategy comes with drug-related deaths in England and Wales reaching their highest level since records began, in 1993, last year.
Turning Point said this made the strategy – which it also strongly welcomed – “timely”.
Chief executive Julie Bass said: “The introduction of new professional standards for the workforce will help improve the quality of services and we are glad to see that the strategy acknowledges the value added by people who’ve experienced drug problems themselves working alongside clinicians to support others in their recovery.
“This is a significant additional investment in the sector and we are encouraged by the fact that funding will be ring-fenced, with local accountability strengthened and a clear focus on reducing drug-related deaths.”