National Development Project Fund (NDPF) - evaluation: final report

2 Learning 

This section discusses learning emerging from the NDPF projects. As noted in Section 1, the focus is on learning of national significance which could, potentially, inform future services to support the delivery of services to reduce problem drug and alcohol use across Scotland. The section focuses on learning for each of the NDPF priorities - advocacy services, family inclusive services, and start-up investment.

Advocacy services 

Advocacy services had been identified as a gap in support for people with alcohol and drug problems with Rights, Respect and Recovery committing the Scottish Government to fund advocacy services through the NDPF to support a human-rights based approach. The strategy outlined the approach and how it could potentially assist people affected by alcohol and drug problems, as shown in the figure below.

A Human Rights-Based Approach

Taking a human rights-based approach is about using international human rights standards to ensure that people’s human rights are put at the very centre of policies and practice. A human rights-based approach empowers people to know and claim their rights. It increases the ability of organisations, public bodies and businesses to fulfil their human rights obligations. It also creates solid accountability so people can seek remedies when their rights are violated.

Clearly everyone has a right to life and health and we need to ensure this is the case for those who experience alcohol and drug problems.

The PANEL principles are one way of breaking down what a human rights-based approach means in practice.

• Participation – People must be involved in decisions that affect their rights.
• Accountability – There should be monitoring of how people’s rights are being affected, as well as improvement action taken.
• Non-discrimination and Equality – All forms of discrimination must be prevented and eliminated. People who face the biggest barriers to realising their rights should be prioritised.
• Empowerment – Everyone should understand their rights, and be fully supported to take part in developing policy and practices which affect their lives.
• Legality – Approaches should be grounded in the legal rights that are set out in domestic and international laws.

We need to apply this approach to how we respond to problem drug use, including service planning, development, delivery and regulation.

We need to ensure that people have access to independent advocacy services to support this approach.

The Scottish Government will invest in advocacy services through the National Development Fund to support the development of a human rights-based approach.

Six of the NDPF-funded projects were advocacy related. Five involved the direct provision of advocacy support to people affected by alcohol and drug problems and were delivered by existing advocacy services. These organisations already had the structures and expertise in place to deliver advocacy to people with alcohol and drug problems. The sixth NDPF-funded advocacy project was delivered by the Scottish Recovery Consortium working in collaboration with another established advocacy service REACH Advocacy. As described in Section 3, this project delivered valuable training and support for peer advocates and awareness raising training for advocacy services about the human rights based approach. Overall, NDPF funding enabled the advocacy services to support people with alcohol and drug problems which they had not been able to previously. 

Although support for people with alcohol and drug problems was broadly similar across the projects, there were also variations, noted below, that provide useful learning for any future rollout of advocacy services in this field. 

• All of the advocacy services supported people with alcohol and drug problems to connect, re-connect or address issues with alcohol and drug services. The advocacy workers helped people to be more involved in decisions about their support and therefore contributed to the Participation element of the PANEL^[1] principles described in the figure above. In the majority of cases, alcohol and drug services were receptive to the involvement of advocacy workers, although there were some isolated examples of individual staff members being less receptive. There was a suggestion from one consultee that staff from statutory services could be less receptive to advocacy than third sector providers although this view was not shared by other consultees. The projects' experiences highlight the importance of other services understanding, respecting and being responsive to the role of advocacy workers.
• All of the advocacy services supported people with alcohol and drug problems to address other issues and services such as housing, debts and benefits. Some of the advocacy services developed good contacts with partners such as housing providers and the DWP. For example, during the COVID-19 lockdown the Midlothian and East Lothian Advocacy Project negotiated two-week extensions for clients to submit documentation and in doing so prevented them from being sanctioned. Equally, there were reports of the opposite situations arising; for example, the same project also reported a housing officer being unreceptive to concerns raised about the state of a particular tenancy. Such experiences again highlight the importance of other services understanding, respecting and being responsive to the role of advocacy workers.
• All of the advocacy services provided a degree of emotional and practical support to people with alcohol and drug problems to aid their recovery. This included listening to people when they wanted someone to speak to and, at times, encouraging them to maintain their recovery. On a practical level it also involved tasks such as picking up medication for people during lockdown, or accompanying them to appointments.
• Some of the advocacy services developed groups and activities (in-person before COVID-19 and virtual since) for people with alcohol and drug problems to combat social isolation, improve mental health and increase confidence. For example, the East Ayrshire project took a group of people using the service on a fishing trip and also instigated walk and talk sessions to enable some form of face-to-face contact and social interaction during lockdown.

In providing emotional and recreational support, the advocacy workers role was comparable to that of substance use support workers and, in these instances, their support could be seen as complementary or, in some cases, a preferred alternative for substance use services. The advocacy workers role here could also potentially overlap with the role of recovery communities which Rights, Respect and Recovery recognised are well placed to lead on the development of recovery capital and reducing stigma within communities, as well as making a positive impact more broadly on their local community. This raises a question about the respective roles of advocacy services, alcohol and drug recovery services and recovery communities where it could be seen as advocacy workers blurring the boundaries with others, and with their objective to signpost people to existing services/groups or to highlight gaps in provision. One of the addiction services welcomed such support from advocacy services, where it was temporary and led to signposting to other services, describing it as a soft transition from counselling to community based provision. It is possible the advocacy workers took on this wider role in response to the closure of other sources of support such as recovery cafés during the COVID-19 restrictions. Nonetheless, in our view, there is a need for clarity in the role of advocacy workers before expanding advocacy services for people with alcohol and drug problems. 

"I was attending [NHS addiction service] but I didn't feel I was getting a good service. I felt like I had to watch what I said – I've had social work involvement in the past. I phoned them to say I was happy to continue to see [advocacy worker] and not them. I had also been attending [third sector recovery services] and I'd had some minor blips with them too so I stopped. I know I can phone [advocacy worker] whenever I need to and I've no plans to go back to the other services." (Anonymous person using advocacy services).

NDPF funding of advocacy services also provided valuable learning regarding advocacy workers with and without lived experience. Represent Recovery in East Ayrshire and Collective Advocacy in West Lothian employed advocacy workers with relevant lived experience and feedback from people using the service highlighted the benefits of their support. It helped build confidence and empower people with alcohol and drug problems which was linked to the workers' understanding of the issues facing those they were supporting, their knowledge of support services and the challenges they could face accessing these services. However, it is important to also state that the NDPF-funded advocacy services where workers did not have lived experience also engaged their target group and were well regarded by consultees including individuals using these services.

"It definitely helped that [advocacy worker] had been through it themselves. Other workers have just read about it in a book. It's like me reading an Andy McNab book and thinking I could be a special forces guy." (Anonymous person using advocacy service).

The NDPF experience of the advocacy services underlines the importance of connections with other services. They all embarked on awareness raising work at the outset to inform and engage services. The AdvoCard service in Edinburgh has a Development Coordinator with the specific remit to make these connections and it was felt by the service that this is a good model for further work, although the need for this may also be dependent on the size of the area being covered. Across the advocacy projects there was a concern raised that other services were not always fully aware of what advocacy was and any additional advocacy services will need to raise awareness of their support, not only at the outset but also at regular intervals. 

Outreach by the NDPF-funded advocacy services was important in engaging people with alcohol and drug problems. This applied in rural areas such as East Ayrshire where access to services, particularly via public transport, can be challenging. More generally, outreach was important in urban and rural areas as people with alcohol and drug problems not engaging with support services are, by definition, harder to reach. The Mid and East Lothian Advocacy Project had relative success in engaging people in active addiction and this highlights the value in making services as inclusive as possible. 

Rights, Respect and Recovery emphasises the importance of services being accessible. One of the key learning points highlighted by the Collective Advocacy Project was the importance of helping people with alcohol and drug problems to overcome practical barriers to engaging with support. The project's success in influencing local services so that people with alcohol and drug problems had access to free bus passes in West Lothian highlighted that 'insider knowledge' brings to the fore the everyday lived realities people face which may not always be known or fully understood. This example also shows how collective advocacy can be a way of pooling resources and experiences to affect change. Moreover, by bringing people together to understand that their situation is not an isolated one, this collective experience of sharing can overcome the individualised stigma and shame felt, particularly when the barriers are related to poverty. 

"I feel like we are being listened to…It used to be that this was just about what the professionals thought, but now it is about hearing from people who are going through it and really understand." (Person using Collective Advocacy Project).

Feedback from both people using advocacy services and providers of alcohol and drug services demonstrated the benefits of advocacy services in this setting. They highlighted the value to those who used the service, as well as the value to service providers of being able to signpost individuals using the service to additional support for issues outwith their own remit.

"Before this had been set up we didn't know what we were missing, but now that it is here it is daunting to think about what we will do without it as it is really needed." (Alcohol and drug service provider).

"[Advocacy worker] sorted out a problem with DWP. I'd been pushed from pillar to post by them and [Advocacy worker] told me what I was entitled to, and what my rights were. I didn't know the ins and outs, what was available, or what I was entitled to. It was a total minefield… I was already hooked into the addiction service but I had a couple of issues. [Advocacy worker] helped me with what to say to them and it worked. They said they'd have spoken to the service for me if I needed them to. I would have been walking around in circles without them… They take the stress out of situations… When they go with you to meetings, the services talk to you better, you normally feel shunned by services." (Anonymous person using advocacy service).

Some of the people with alcohol and drug problems supported by the NDPF-funded advocacy services were from specific groups that the services already focused on, such as those with mental health challenges, those with criminal justice involvement, young people, or older people. There was therefore an element of duplication, whereby a number of people with alcohol and drug problems would have been able to access existing advocacy services. Our research confirmed that this was particularly the case with people with both substance and mental health issues, with a number of referrals from mental health workers. In some of these cases mental health appeared to be the primary reason for their engagement with the NDPF-funded alcohol and drug advocacy services. This led us to question the added value of the NDPF-funded advocacy services in these situations. While we appreciate that alcohol and drug problems and mental health can be interlinked, it would maximise the effectiveness of funding for advocacy services for people with alcohol and drug issues, in our view, if referrals, signposting and awareness raising focused on alcohol and drug issues. There was some evidence that advocacy services with dedicated alcohol and drug advocacy workers had a clearer focus on people with these issues than those that integrated support for people with alcohol and drug problems with their existing services for people with other issues.

Advocacy services have an important role in helping inform and shape recovery orientated systems of care. The NDPF-funded advocacy services also had some influence at the strategic level as demonstrated by the following examples. East Ayrshire Advocacy Service was an active member of the Alcohol and Drug Partnership and regularly shared emerging experience and learning with partners. It was reported that this helped make recovery more visible in East Ayrshire, especially the rural areas where services were more scarce, and advocacy was referred to by one strategic consultee as being an important part of a journey from medically-based treatment to a more community-based recovery modality. This led to the Integrated Joint Board funding an ADP proposal to invest in peer-led recovery support. In West Lothian, as discussed in Section 3, the Collective Advocacy Project met with the manager of the Community Mental Health and Addictions Service and was able to influence future plans. It was also reported in Section 3 how SRC's peer advocacy training and support in Argyll and Bute directly led the ADP to invest in peer-led advocacy workers. These examples show that advocacy services have an important role in helping inform and shape recovery orientated systems of care. It is vital, in our view, that advocacy services have the opportunity to share their learning with alcohol and drug services and commissioners, ideally at a strategic level via ADPs. Rights, Respect and Recovery promotes an intelligence-led approach and part of this is about understanding the changing trends in need and service use. Based on the NDPF experience, advocacy appears to be well placed to have a role in broader discussions that seek to inform policy. 

Family inclusive services 

Rights, Respect and Recovery included a commitment that families affected by alcohol and drug problems have access to support in their own right and there was recognition of the stigma faced that can isolate families from their communities. Carers and Kinship Carers were also identified as groups requiring support within communities. Key learning from the two NDPF-funded family inclusive services – Families as a Movement for Change and South Ayrshire Kinship Family Support Service – is discussed below.

Both services highlighted that young people (particularly those aged around 12 to 16), kinship carers and family members more widely affected by substance use can be 'hidden' with limited support currently available in the community. The invisibility and isolation of those supported by the NDPF funding was evident throughout, with lockdown further highlighting the severity of their need through, for example, highlighting the need for emergency food provision and addressing digital exclusion.

South Ayrshire Kinship Family Support Service reported challenges in engaging statutory services in new ways of working and suggested, by way of learning, that establishing stronger links with senior managers at the outset may help services in other areas seeking to implement a new approach. Where the service was able to engage kinship families, via statutory services, significant benefits were reported and this generated some useful learning. The service demonstrated the positive impact which support can have on kinship families that would otherwise struggle to access any support. There was also a suggestion that kinship family support could, potentially, alleviate pressure on social work.

"If it wasn't for the service giving me the support I would have been stuck in a terrible situation… It's a brilliant idea that there is support for kinship carers who no longer need social work involvement. It must free up social workers for children who do need them. I'm quite sure that they can see that the children who don't need social workers are quite safe and secure where they are. It was a shame social workers were coming to give us support when there was children out there who need them more. Most children in kinship care are safe and happy. When I used to talk my grandchild to nursery the other parents there were all my age. All these grandparents are left with these children, from the lost generation. That's what I call them, the lost generation." (South Ayrshire Kinship Family Support Service beneficiary).

"With kinship carers there's no other support available for them. There's a strong theme that kinship families need support, they no longer need social work intervention but there's a huge gap, they still need ongoing support. It's a very complex and challenging journey for kinship families in relation to the children's adverse experiences, their trauma, but they've got nobody to help them navigate their way through that. There is a huge gap. This project has shown there is a huge need for intensive support for kinship families, for both carers and children in relation to their journey. There are so many challenges around their age, the generational challenges around technology, especially around our current climate, there's real financial pressures on kinship carers as well… Carers feel extremely isolated. They tell us that in their family networks nobody really understands how complex and challenging kinship caring can be." (South Ayrshire Kinship Family Support Service beneficiary).

One of the key learning points arising from the 'Routes' Project which was part of the Families as Movement for Change initiative, was the need for teachers to be more aware and attuned to the specific needs of young people affected by substance use, and to support them to remain in school. Similarly, some of the young people supported by the Kinship Family Support Service, faced challenges at school, such as bullying, that the service helped the families address. The links between school exclusion and the impact on life chances is well established within research^[2]. The Families as a Movement for Change Initiative also emphasised that families preferred not to simply sit and talk about their problems but engaged more readily by doing, and building organic networks through action together. 

"The big difference is connecting with someone who really knows and has been there. It is amazing to see how people have really come out of their shells and are telling their story. We had one mum who always used to give her money away to her son (who had alcohol and drug problems) and have nothing for herself. Now she will buy him gas or electricity but she doesn't give it all away. I think that comes from the CRAFT training. I have also seen that people's mental health has really improved and that includes the children." (Person using the Families as a Movement for Change service).

Start-up investment 

Scottish Government funding for start-up investment demonstrated a notable commitment to finding new and innovative ways to deliver Rights, Respect and Recovery. Key learning from the two NDPF-funded projects – River Garden Auchincruive and Recovery Peer Partnership – is discussed below. 

NDPF-funding for a CEO at River Garden Auchincruive was beneficial and other organisations at the same stage of development could, potentially, benefit from similar support. NDPF allowed the project to develop in ways, and at a pace, that would not have been possible without external funding as the role had previously been undertaken by volunteer Trustees. It was reported that governance issues impacted on the CEO's ability to fully meet the job specification and other projects in a similar position could learn from this experience. Respondents from the organisation suggested that others in their position should think carefully about what the needs of the organisation are at that time as, in hindsight, an operational lead may have been more appropriate than a CEO. 

Although the NDPF funding for River Garden Auchincruive CEO was primarily to aid organisational development, the project also generated learning at an operational level which may be of interest to those involved in ongoing discussions about residential rehabilitation in Scotland. The CEO worked closely with staff, Trustees and residents to develop a recovery orientated model of care - the River Garden Way - for very long-term residential rehabilitation. Although similar to approaches in other countries, the River Garden Way, was seen as reflecting the unique circumstances in Scotland with its emphasis on building a supportive community. 

Although another NDPF-funded project, the Recovery Peer Partnership set out to promote peer-led recovery 'pathways' it was unable to bring people together as they had envisaged because of COVID-19 restrictions. The project reported, however, that the connections and structures were in place to establish these pathways in the future. Factors restricting access were around digital exclusion. It was also reported that some potential beneficiaries were wary of digital technology, suggesting mistrust may be a barrier to the use of digital  communication. The Partnership report having a 'blueprint' for working with people who are affected by alcohol and drug problems in rural areas could be particularly beneficial in the future as there is growing awareness that this is a different context that requires more attention^[3]. The Partnership also emphasised the importance of accessibility to peer-led recovery support, particularly linking in with services such as DWP and NHS to engage people in active addiction who are accessing these services.