Open all hours

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