As social care prepares for a radical shake-up, it may be time to axe generic emergency duty teams and adapt existing services to do their work in an integrated setting, says Chris Larkman
Although social services changed to a more specialist approach many years ago, the anomalies of a generic emergency duty team (EDT) service co-existing in a specialist world have been overlooked.
But generic EDTs cannot continue because:
Social services EDTs were formed in the 1970s, and they have fostered a unique breed of worker. Unlike day teams, the night workers operate mainly alone, often from their own home. The lifestyle is not for everyone, but for some it has helped with child care arrangements.
Senior management has given scant attention to the night owls because, by and large, EDTs have performed well. In any event, managers have had their time taken up with the constant demands of restructuring day services. Under the section on EDTs, the London child protection procedures give us little more than a note stating “this section requires further development”.(2) This is typical of the way in which EDTs come at the bottom of everyone’s agenda.
There has been talk of change within EDTs for many years. Nothing has happened and workers have become accustomed to ignoring such threats. They may be tempted to bury their heads in the sand again, but this time it is for real. The services, as we have known them, will vanish and be realigned. But unless management starts planning now, the likelihood is that EDTs will be dealt with as an afterthought and decisions made at the last minute.
The key to plotting a way forward lies in examining what a service actually does, considering what it needs to do (for example, statutory work), what it perhaps should not be doing and who else may do some of the work more effectively.
The bread and butter of any EDT is child protection and mental health assessments. The focus, therefore, should be on a solution to cover this work. Children’s departments are planning to extend their core hours of operation, and many are developing out-of-hours services covering emergency placements for young people. This presents an ideal chance to design an integrated children’s out-of-hours service.
In terms of mental health, integration with the home treatment service may be an option, offering a joined-up service to people presenting out of hours with mental health problems. In some urban areas, pooling services between neighbouring authorities (say, within a mental health trust area) may be a sensible way forward.
In terms of work with older people, many primary care trusts are trying to design a one-stop out-of-hours service. The time is, then, ideal for negotiation. Most referrals for older people relate to home care arrangements and many of these calls could be responded to better by the providers directly. A specialist resource centre may be the best place to respond initially to calls for people with learning difficulties. EDTs have traditionally taken on homeless people on behalf of the housing departments, and this service could continue to be covered by a children’s EDT – a preferable arrangement taking into account the number of vulnerable children involved.
If your EDT undertakes appropriate adult work, then stop doing it (except, of course, where there is a child in your care or a major crime involving a vulnerable adult.) If your authority does not have a volunteer appropriate adult scheme, make arrangements to set up one. The scheme should cover children and adults. If your EDT is expected to take on failed visit investigations, such as when the home care service or meals service arrives and cannot get access, be firm. Any sensible authority contracts with the provider to undertake this work, except perhaps in exceptional situations. The reason they normally end up with EDTs is because no one has taken the effort to obtain useful contact information at the original point of referral.
Now is the time to think laterally about out-of-hours services. Think about them in the light of what is being planned over extending current day services. Consider the tasks that will be required of each service. How can these tasks be best met and by whom in any future service alignment? Look carefully at your statistics to understand what is happening. What time do the referrals come in? How many referrals result in a visit and for which clients? How many referrals come in overnight and which services do they represent? Could your call or contact centres be used in a different way to deal with initial enquiries? Could some of the services be offered by others, such as health or Care Alarm, or dealt with on a call-out basis – for example, by a bank of approved social workers paid a fixed sum for an assessment?
Emergency duty teams are relics of the great generic social work days and they need to be put where relics belong – in a museum. Plan now for their replacement.
Chris Larkman has 20 years’ social services experience, and has taken a special interest in the workings of emergency duty teams. He has worked as a locum and as a manager in several London boroughs. He now runs a consultancy to assist local authorities re-organise their out-of-hours provision (email@example.com).
Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.
This article looks at the functioning of the social services emergency duty teams which have been operating a generic service for more than 30 years. It recommends that action is needed now to evaluate the service in order to realign with the specialist day services.
(1) The Victoria Climbie Inquiry, Lord Laming, Recommendation 47, The Stationery Office, 2003
(2) London Child Protection Procedures, London Child Protection Committee, pp13-14, 2003. www.londoncpc.gov.uk.
Open All Hours? Inspection of Local Authority Social Services Emergency Out of Hours Arrangements, Social Services Inspectorate, 1999
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