Liz MacDonald is a policy manager at the Scottish COnsumer COuncil where she is responsible for policy on health and social care.

Services that respond to emergencies face difficult decisions about how to provide a service which is sufficient to meet the need, but which also makes the best use of often limited resources.

In Scotland each local authority has to decide how to provide a sufficient level of cover to deal with emergencies that happen after mainstream social work offices are closed.

Such cases are often difficult and sensitive to deal with, involving child protection and mental health issues, or people who are particularly vulnerable or frail.

Recent research by the Scottish Consumer Council shows that there is considerable variation in how local authorities in Scotland provide this service. It decided to carry out this research after finding that very little had been written on how services are provided in Scotland.

This contrasts with England and Wales, where there have been inspections of the service, and standards have been developed. Almost all the research about this area of service provision has also taken place in England.

In Scotland, some councils work together, often in groupings that match the previous regional authority boundaries, for example in the west of Scotland, where a large standby service covers 13 local authority areas from a single office in Glasgow.

There are three other services provided on a regional basis, covering the former Tayside region, central Scotland, and three authorities which were formerly part of Lothian region. Staff in these services tend to specialise in out-of-hours work, which requires a broad range of experience, and an ability to tackle any problem that presents out of hours.

At the other end of the scale, the small, island authorities expect their mainstream social work staff to take part in an out-of-hours rota.
In between, there are several local authorities which work with differing staffing and access arrangements.

From the point of view of those using this service, we were interested to know more about how people contacted the service, and how easy it was to get information about the service, both in English and in minority languages and alternative formats.

Where services covered more than one local authority area there appeared to be some confusion about who took the lead in publicising the service. In some areas, information about the emergency out-of-hours service was limited to a phone number on general information about social work services, whereas other service providers adopted a more proactive approach, producing information specifically about the emergency service and making this information widely available.

The overall impression was that not much was done to publicise the out-of-hours emergency service. Very little information appeared to be available in alternative formats or minority languages, and only two service providers carried out any ethnic monitoring of the service. Some of the regional providers seemed to have been more proactive in publicising the services than others.

There was little evidence of these services consulting their service users to get feedback. One provider had done some research with service users as part of a Best Value review, and one had carried out some customer satisfaction surveys. Some providers said they would like to do more in this area, but found it difficult to know where to start, and were concerned about confidentiality issues.

A greater number of service providers said that they monitored feedback from service users through the complaints process. But there was a lack of clarity about where complaints about the emergency out-of-hours service would go - with some being dealt with by the local authority, which might not be providing the service itself, through its social work complaints procedure. Others said complaints would be passed to the out-of-hours service.

We explored the concerns of those providing this service, as well as the concerns of local authorities in Scotland that purchase a service from one of the regional service providers. This uncovered a wide range of issues - ranging from concerns about meeting the demand, particularly in certain areas such as mental health, to the difficulties of interagency working, and the quality of the service being provided in remote and rural areas. Many respondents mentioned resources being a serious issue for the service, with increasing demands for work in the areas of child protection and mental health.

They also recognised that quality of service was one of the key issues for the future, as was the need for the development and use of standards.

Several mainstream social work departments are extending particular services beyond traditional working hours, for example in home care support, or intensive support for a particular client group such as people with a mental health problem. While this is a welcome development, it can lead to confusion as to who has responsibility for dealing with a particular case out of hours. Staff working for mainstream services beyond normal working hours are uncertain whether the emergency service always refers cases on to them correctly.

Based on the variation that currently exists across Scotland, the report calls for a review of the way these vital services are provided when mainstream social work offices are closed. The areas which such a review could address would include the relationship between mainstream social work authorities and the out-of-hours service, and the extent to which emergency out-of-hours social work services are working effectively with other agencies providing care out-of -hours. Such a review would help raise the profile of this service, and the need to provide a service meeting consistent standards across Scotland.

The report makes a series of recommendations to current service providers and local authorities, including reviewing how the service is publicised, and the quality of information provided to those who may need to use the service.

Finally, emergency out-of-hours service providers should make a greater effort to explore the needs and experiences of individuals who have used the service.

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.

Abstract
This article looks at the findings of research into how emergency out-of-hours social care is provided in Scotland. It argues that there should be a national review of the quality of the service. It also concludes that there should be national standards developed.
further reading

• The report can be found on the Scottish Consumer Council website at www.scotconsumer.org.uk
• D Clifford and G Williams, "Important yet ignored: problems of 'expertise' in emergency duty social work", British Journal of Social Work, 2002:32, 201-215
• Department of Health, Open all hours?: An Inspection of Local Authorities Social Services Emergency Out-of-Hours Arrangements, 1999
• B Sawyer and D Ingram, Public Views of Social Work Services in Scotland, Scottish executive, 2000
• Scottish Development Centre for Mental Health, "Mental health officer services: structures and support", Research findings 32, Scottish executive, 2003
• Social Services Inspectorate for Wales, Inspection of Local Authority Social Services Out of hours Emergency Duty Service, 2001

Contact the author
E-mail: lmacdonald@scotconsumer.org.uk or tel 0141 227 6451