Calling time on 9 to 5

Sod’s law states that if there’s going to be a crisis, it will
happen at the worst possible time. This has long been recognised by
police forces and the medical profession.

But despite facing a similar range of out-of-hours crises, social
services departments are still resolutely 9am to 5pm organisations.
It is not unknown for someone fleeing domestic violence to arrive
on the steps of social services at 5.30pm on Friday, only to find
the lights off for the weekend.

This “office hours only” culture does not extend across all parts
of the social care sector – domiciliary care workers sometimes
arrive at a client’s home at 7am or leave late at night. And most
social services departments do provide a service out of hours,
often through an emergency duty team (EDT). But at any one time
there is often only a lone worker on duty who has tightly defined
service criteria that are limited to unplanned, unexpected and
sudden crises that have to be resolved without delay.

Research suggests that EDT workers are some of the most experienced
and well-qualified social workers in the country.¹ They
provide a generic emergency service; about 65 per cent of their
work is child protection-related and much of the remainder centres
on mental health. The work can be lonely and stressful, but EDT
workers enjoy unparalleled autonomy and many say the hours suit
them.

But times are changing and such a focused emergency response is no
longer sufficient, say some. In 1999, the Social Services
Inspectorate report Open All Hours² suggested
that social services departments should consider providing more
services out of hours in response to public expectations.

More recently, the Victoria Climbi’ Report concluded that
specialist services should be available “to respond to the needs of
children and families 24 hours a day, seven days a week”. The
government has yet to respond to recommendation 47, but it raises
the possibility that children and families teams will be open for
business at antisocial hours.

More recently, the Community Care (Delayed Discharges) Act, which
introduces fines for social services for delaying discharges from
hospital, has been the subject of heated discussion in the House of
Lords.

The issue here is about whether hospitals can charge social
services for delays over weekends and public holidays when social
workers would not normally be at work. Saturdays will now be
classed as a chargeable working day, and Sundays and public
holidays are likely to be included by April 2005 (news, page 8, 3
April).

The only way social work can provide a truly 24-hour service is by
introducing shifts for the majority of the social care workforce.
But is that really an option?

Glen Williams, an EDT worker and chairperson of his local branch of
Unison, says: “The government’s stance on this seems to be that
having an emergency duty system is not enough because people don’t
just operate 9am to 5pm.

“But I don’t think anyone is suggesting it should be a service that
operates fully round the clock. Not many people are calling up at
5am asking for a family support worker, and I don’t think there is
any suggestion that that should be on offer.

“But I do think they are keen to extend the core hours of social
work – so that rather than working between 9am and 5pm, you have a
core service which is available from, say, 6am to 10pm.”

But he adds: “In my experience there would be massive resistance to
the idea of moving towards a shift system, or any significant
change to the current emergency system.”

¹ Glen Williams, Out of
Hours Social Work: A Study of Local Authority Emergency Duty
Teams, Liverpool John Moores University. For further
information contact him on
glenwilliamsedt@hotmail.com
 

See also his piece to be published in Community
Care, 1 May.

² Department of Health, Open All Hours, Social
Services Inspectorate, 1999. Free from
www.doh.gov.uk/pub/docs/doh/oahrep.pdf 

The trouble with shift work

Nora Dudley is a recently qualified social worker. “I have mixed
feelings about a 24-hour service. If social workers were on hand
all the time I’d worry that it could promote a dependency on social
work intervention among clients who may not necessarily require
such intensive support. I work in children’s services and I feel
that while our emergency duty team provides an excellent service,
its ’emergency’ status dissuades people who are able to sort out
their own minor problems themselves. If the ’emergency’ status was
removed by 24-hour social work coverage, I’d worry that a whole
group of clients who might prefer to involve social workers rather
than use their own skills and abilities to resolve things
themselves, will be given the opportunity to do just that, 24 hours
a day.

“I personally like shift work and wouldn’t have too many major
problems with it. However, I am young, without commitments such as
children and I am just starting out on my career. Many of my
colleagues with children would find shifts much more
difficult.

“I also worry that shift-type working hours may remove yet another
source of stability for young people. Those on my caseload know
that I will usually be around from 8am to 6pm to ‘sort things out’.
If I begin to work shifts, how will these young people know when I
am around? Shift patterns are never straightforward so I can’t
imagine that my young people will get to grips with it. I am, for
many of my young clients, one of the few reliable factors in their
life and I worry that if this is removed or tampered with, it may
add to the confusion in their lives.

“Also, how many social workers start bang on 8.30am and leave at
5pm on the dot? There are always the crises at 4.59pm, the visits
that go on for hours, the meetings that drag on, the young person
who discloses abuse when you are driving them home. If social
workers were suddenly put into shifts, how would these shifts be
protected from the myriad of situations which causes social workers
huge amounts of unpaid overtime? Surely a 9am to 5pm day is much
easier to extend in emergencies than a shift pattern that may have
you finishing at midnight or starting at 5am?”

Flexibility needed

Paul Jewitt is an approved social worker. He says: “I remain to
be convinced that a 24-hour system would improve services for the
better, and it could well lead to serious recruitment problems –
inevitably the pay would be inadequate to compensate [for
antisocial hours] and the bill to local authorities would be
doubled or more. 

“This is heading towards an NHS takeover, which would be a
disaster. It is the nursing love affair with long hours and
overtime that has driven some areas into providing a 24-hour
assertive outreach model that exists only because someone has
decided there is a need, without any evidence. 

“All the research that looks seriously at performance shows
that, after six hours on a shift, attention spans become shorter
and efficiency declines rapidly. We should be looking at more
flexible working within the hours already committed to rather than
a rigid and inflexible shift system.”

Where staff are on call all night

Hampshire is one of the few authorities that has really bitten
the 24-hour bullet. A bid for money from the e-government
initiative four years ago resulted in £1m to invest in a new
“open all hours” scheme, Social Services Direct.  

This “service centre” takes over at 5pm and staff are available
all night and all weekend. All calls – even direct to social
workers’ desks – are rerouted through the service centre out of
hours, which means that people can call at any time to leave
messages for their social worker, find out how to get a commode or
report emergencies.  The centre operates three levels of service.
The first is a simple call centre where operators take messages,
refer people to the right department, and provide information about
council services. The next tier is for people who don’t qualify as
emergency cases but who need a social worker’s or care manager’s
attention. The third tier is equivalent to an EDT, with a team of
three or four specialist child protection and mental health social
workers – some of whom are dual-trained. Case files are available
to staff through a shared computer network so that day workers can
flag up any concerns about possible crises to out-of-hours workers
and vice versa.  “It is an entirely separate staff group from the
main body of social work, with separate management,” says Glyn
Jones, a manager with Hampshire Council who is responsible for
Social Services Direct. “Staff come in at different times depending
on when they are likely to be most busy – so operators arrive early
because they are really busy between 5pm and 6pm. Other groups of
staff tend to be busier later, so they arrive later.” 

He says recruitment has not generally been a problem, but admits
that working at night suits only some people. “I think it depends
on the sort of person you are, and what else you’ve got on in your
life. You need to enjoy working on a permanent crisis-resolution
basis.” 

The Hampshire model did not come cheap, involved significant
retraining and had to overcome several technical hurdles. But it is
one example of a sensible compromise between a full 24-hour service
and the current situation. It has also, Jones says, provided a
useful platform in discussing emergency responses with the local
primary care trust, and works in co-operation with NHS Direct. And
new services, for instance an out-of-hours carers’ helpline, are
relatively straightforward to bolt on and are in the
pipeline.