A social worker from a hospital discharge team called our organisation last week in a panic. She is about to discharge a vulnerable, anxious patient who cannot go home alone. The patient is a typical “revolving door” case – frequent unplanned admissions into A&E, safeguarding issues with family members who appear to obstruct discharge and inadequate support at home but she doesn’t qualify for “reablement care” and can’t afford to pay for services.
The social worker asks, “Can you arrange for a volunteer to take Mrs Kelly home and settle her back in? And can they also provide some household support for six weeks; shopping, cooking, that sort of thing.” As if it were that easy.
I wonder whether she thinks, perhaps in desperation, that there is a magic hat somewhere from which we can pull unlimited competent, highly trained volunteers who have lots of flexible free time, and are available at short notice. I tell her that our six volunteers, who also work full time already, are only trained and able to carry out a role on a project that has been commissioned, which incidentally also involves just one hour per week on a fixed day So no, I cannot arrange this. And it would be inappropriate to put a volunteer into such a complex sounding situation anyway, although this doesn’t occur to the social worker, who just needs a quick solution to the situation because she is under pressure to close the case. Now that often means “hand over to the voluntary sector to haphazardly manage the client’s ongoing wellbeing in the community”.
There is a volunteer service based at the hospital she is calling from, which provides “going home” support for vulnerable discharged patients. I tell the social worker to refer Mrs Kelly to them.
“They don’t cover this ward”, she says. Their funding is attached to particular wards only. Taking on exceptions would skew the outcomes and figures they need to report to the funders. So even within one hospital, there is no blanket volunteer service in place that can support patients post-discharge. Entitlement to the “going home” service entirely depends on whether you manage to have a stroke or a heart attack and land yourself in the right ward. Mrs Kelly didn’t land in the right ward.
The social worker pleads with me. This is not how we are supposed to accept referrals into our service and I have a waiting list four weeks long of vulnerable people to see. While the name of my organisation and my job title might indicate that I am there to help vulnerable people live independently in the community, the reality is I am not funded to help this person. Mrs Kelly is not the right age, she doesn’t live in the right postcode area, and she doesn’t need the sorts of services I am supposed to be providing. Helping her will mean I spend less time spent on the people that I am funded to support.
Fortunately my organisation recognises the arbitrariness of such remits and so as much as possible we try to unbind ourselves from the red tape. I compromise with the social worker; I will meet Mrs Kelly at home on the day she is discharged and settle her back in. I will then take on the burden of trying to find free ongoing domestic support for her, so the social worker can close her case.
But then the rollercoaster begins, as I will inevitably end up signposting on to other organisations, who will need to follow their own protocols and assessments to decide if Mrs Kelly fits their criteria.They are not obliged to tell me if she does, and I am not obliged to chase it up. She will get dropped in transition somewhere along the way, and ultimately end up back in hospital. And maybe by that point she’ll have deteriorated to such an extent that she qualifies for a social care package.
There are many people like Mrs Kelly juggled around in the voluntary community sector because they do not quite reach the ever higher threshold for ongoing statutory support. If we were just an “added bonus” on top of a well-resourced health and social care sector, I might not be so concerned. But our sector, known for having no money, no authority or accountability, is being commissioned to replace and provide vital services. When we are brought in what you actually get at your most vulnerable is a postcode lottery of chaotic services and waiting lists, arbitrary conditions and criteria you may or may not be fortunate enough to meet, and a time limit on the support available. This is because local councils and commissioners, under pressure to come up with “innovative” (and cheaper) ways to address their population’s needs, can only offer short term and one-off pockets of funding for specific services, which local voluntary and community organisations then bid for. So while an organisation may continue to exist as a name the services they provide can be there one minute and gone the next.
Those who work in the sector are lucky if their role is funded for a year; usually we are hopping from one expiring project to the next pilot every few months. It is impossible for professionals and the vulnerable people trying to access our services to keep up. They might be referred into a service which then expires before they get to the top of the waiting list. Despite our best efforts, we cannot fill the void effectively and we will all suffer for it.
