Plans for seven-day social work services will require investment and support for staff to succeed

Councils prepare to implement seven-day services to support people to leave hospital and prevent emergency admissions by 2015-16

Social workers being asked to work weekends is neither new, nor unusual.

Joe Godden, professional officer with the British Association of Social Workers, remembers having to work weekend shifts as a hospital social worker back in the 1980s.

“There have always been social work emergency duty teams,” he adds. “But the reality is that they usually provide a minimal response [at the weekends] and they often have to fob things off until a Monday morning.”

However, as part of its determination to have an NHS that operates at full potential across seven days, the government needs social care services involved in hospital discharge, reablement and preventing unnecessary admissions to do the same.

Thus one of the conditions for gaining access to the integration transformation fund, the £3.8bn pooled budget planned for 2015-16, is that councils and their partners must have seven-day working either in place, or as part of integration plans.

Issues around delayed discharge are not new and some councils have already moved to extend staff contracts to cover evenings and weekends in an effort to tackle it. But Godden says it is piecemeal and inconsistent at the moment, while a recent audit of

intermediate care services found some 15% of reablement services were not available every day.

Pressure to discharge

“I don’t think anyone has an issue with the idea that social care and hospital services need to be seven-day services but social workers doing it also need support in place,” says Godden. “Currently they are in a vulnerable position where they are placed under a lot of pressure to get people discharged inappropriately and they are unable to access advice and support.”

Godden says he experienced such a situation when a junior doctor was putting pressure on him to discharge an 80-year-old woman with no identifiable illness.

“I agreed and the woman’s sister, also in her 80s, agreed to take her home. The woman died that night and the sister was terribly upset. I have always felt awful about that case, even though it happened a long time ago, because I should have stood up to the doctors. She may not have had an identifiable illness but she was obviously not fit to be on her own and I should have dug my heels in.”

Godden also points out that getting social care services to operate across seven days will not solve problems in the NHS.

“The consultant in that case was very upset and said if he’d been on shift it would not have happened. I think that’s illustrative of the fact that hospitals need to be offering a seven-day service as well and not relying on junior doctors and junior nursing staff at weekends as they currently do.”

Also, latest figures show that two-thirds of delayed discharges from acute hospitals were attributable to the NHS in September 2013, and just 27% to social care.

It should not be a massive stretch for many councils to provide seven-day services, says Andrew Webster, associate director, integrated care, at the Local Government Association, and its lead on the implementation of the integration transformation fund.

Flexible hours

Councils have found that social workers are receptive to the idea of flexible hours over seven days, he says. However, to be effective, seven-day working will need to cover services including home care and emergency housing repairs, he says.

“We need to look at what services will be needed,” he says. “Generally it is someone to accompany a patient home, make sure they have their keys, that there is food in the fridge, that they have a list of contacts etc. Many of these could be volunteers or simply an extension of existing services. Ultimately however the services needed should be dependent on the person’s circumstances, not the fact it is a weekend.”

It is still too early to assess in detail what the overall impact might be on the social care workforce, according to Joan Beck, joint chair of the Association of Directors of Adult Social Services’ workforce network.

“Local authorities across the country are at different stages of development in this respect but it is hard the calculate the impact in full, because the overall position is not yet known in full.”

More detail is expected in a forthcoming report from NHS England on how the health service can move to a seven-day week.

Seven-day services ‘needed to tackle winter crisis’

However, for some this is not soon enough. Many doctors have called for the introduction of seven-day services immediately saying it is needed in order to handle the coming expected winter crisis in the NHS. While the British Medical Association has shied away from dates, a spokesperson said it would like to see changes sooner rather than later.

But Webster points out that this will have to be an individual local authority decision, likely to be dependent on money.

“Even though the money for the integrated budget is already in the system, it is not required to be pulled out of current budgets to go into the integrated budget until 2015-16.

“If it was possible for a council to shift to seven-day working without extra cost then I’m sure they would do it. But otherwise they won’t be able to do anything until they have a whole investment plan in place to gear the move.”

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