by Hannah Layland

I WORK for a local organisation which supports vulnerable adults living independently in the community.

Like others in the voluntary community sector, our team is small and our services are in high demand and chaotic.

The phone rings at five past 12. It is a stressed social worker chasing up the two emails he sent us only minutes before, which are asking rather bluntly if our worker has installed the key safe he has requested yet — because his vulnerable client is due to be discharged from hospital this afternoon and we had apparently booked it as a morning job.

For those who don’t know, a key safe is a little box which gets secured to the walls of older or disabled people’s houses. It holds a spare set of keys so carers/relatives can let themselves in without the person having to come to the door.

Unfortunately for the social worker, city centre traffic does not respect our booking sheet.

I call Pete, who works on our odd-job service. He is en route to the client’s home (his fourth job that morning) but is stuck on a bus in road works.

This is frustrating news for the social worker, but it is what you get if you rely on the scarce resources of the voluntary community sector to fill in the missing pieces of a woefully inadequate discharge procedure.

My local organisation employs two part-time odd-job workers. They are in their sixties and get around our catchment area using their bus passes, which is just as well because our organisation would struggle to cover their travel expenses, and we certainly can’t provide them with a van.

What we are fortunate to have is just enough funding so that we can offer an odd-job service that is free to the vulnerable recipients and the professionals requesting our service.

They do essential maintenance like changing light bulbs, nailing down puckered carpet, putting up curtains etc. So it is no surprise that when we realised we could try to aid hospital discharge by helping to install key safes outside people’s properties, social workers began flocking to us — because this had been a longstanding gap in public-sector provision. We have been managing their unrealistic expectations ever since.

With the pressures of “bed blocker” hysteria bearing down on them, social workers are looking for quick fixes to the complex situations that often prevent someone being discharged from hospital.

We have all heard the stories of older people being sent home and then carted back to hospital immediately because no-one has keys to their property, a next of kin cannot be contacted and the pre-arranged care package cannot commence because the carers cannot access the property. Having a spare set of keys secured in a little box on the wall — a key safe — can solve a lot of problems.
Pete eventually arrives at the client’s home, but he is prevented from installing the key safe that the social worker is agitating for because said social worker has not obtained the necessary written permission from the housing association their client rents from, despite telling us he had.
The housing association has its reasons for refusing. There are already seven key safes outside the property, for the other residents in the block of flats — and such a cluster makes it obvious to the public that vulnerable people live there, so they are increasingly a target for abuse.

In vain the social worker tries to convince us that he had obtained verbal permission, despite the housing association showing Pete their explicit refusal in email correspondence.

When a discharge date is looming social workers are pressured into “act now, face consequences later,” but our workers are liable at the end of the day so the key safe is not installed.

It is a wasted journey for Pete, who sees no gratitude for his time and effort. He moves on to his next job, where he will explain to an older person who has been sleeping on their sofa for days why he couldn’t come to assemble their new bed until this afternoon.

The social worker has gone from haranguing our phones and email accounts to disappearing altogether — no doubt panicking at his unravelling plans which had hinged on that little box on the wall.

Since picking up the phone at five past 12, three more “urgent” key safe requests have arrived in our inboxes from social workers, and Pete’s other jobs scheduled for that week start backing up like a traffic jam.

Vulnerable people’s “less urgent” jobs have to be postponed or cancelled at short notice.

Hospital discharge teams quickly realised they were onto a good thing with our obliging, flexible and effective service. But the potential compliment in this soon wears off when our workers are sent on wild goose chases because social workers haven’t had the time or resources to prepare things effectively. It is such a waste of our already limited capacity and resources.

But the discharge teams know we aren’t going to complain about how exploitative it feels when they bulldoze in and out of our days desperate to have one of our workers at their beck and call, because organisations like mine are treading water just to stay in existence and we mustn’t bite the hand that feeds us.

Instead we should be grateful that statutory services are in such dire straits that they have come to rely on our services — otherwise our workers might not have a job.

But this situation is not sustainable. Already we are having to refuse key safe requests altogether because we just do not have the capacity to do them.

Patients stay in hospital longer than they have to, and we are chastised by social workers for daring to offer a service that we cannot reliably deliver on, for setting an expectation that we cannot meet.

It is they who have set the unrealistic expectation, out of desperation and a lack of anywhere else to turn.

But I can hardly blame them — when it comes to having your backs against the wall, public-sector workers are not much better off than we in the voluntary community sector are.

What is brewing under the surface for all of us involved is the knowledge that NHS and council services have been consistently underfunded and overpressurised for too long.

Third-sector organisations like mine are increasingly feeling the repercussions of this.

What is almost tangible from everyone involved is resentment that our scarcely resourced voluntary community sector has to be relied on so much, in the absence of a properly funded integrated service that can bridge the gap between hospital and home.