By Denise Cheung
Coming from a community social work background, I joined the hospital social care team approximately six months after they became an integrated team. Three years later, I’m looking back on my experience and reflecting on some of the key issues I’ve come across. Does integrated working work and what has changed?
‘What do you do? Understanding roles and overcoming frustrations’
This may sound obvious, but I think a key starting point when the integrated team began to carve out its foundations was learning what each member of the team actually did.
I had personally picked up a sense that other members of the multi-disciplinary team had, at least on one occasion, thought: ‘Why does it take so long for a social worker to get anything done? And I’ve heard people say: ‘Why are social workers always typing?’
Having no choice but to collaborate in order to make a discharge happen, our health colleagues learnt the ins and outs of daily social work practice, and vice versa. They soon became aware of the ‘three p’s’ – policy, procedure and paperwork – that constitute a major part of our work. I believe this helped to reduce colleagues’ frustrations with each other and created a more supportive and understanding working relationship.
‘Keeping the patient’s voice alive’
Much of my work consists of completing mental capacity assessments and making best interest decisions on the patient’s behalf regarding residency and care. With contributions from multiple professionals and family members, there is an abundance of information and varying proposals for discharge plans.
Here, key social work values come alive. Autonomy, choice and control, the service user being the expert on their own lives, personalisation, and advocacy.
When unable to reliably contribute due to the impact of dementia, the patient can literally lose their voice in the assessment and decision making process. Even patients that do have the cognitive ability to make decisions regarding their own discharge can have their voices drowned out by people who know the process better and think they know best.
It is my role as a social worker to ensure that the patient remains at the centre of the assessment and to address power imbalances.
It is a blessing to have multiple experts contributing to the assessment and decision making process because this enables more informed, holistic and robust outcomes. This is particularly wonderful when all involved professionals, and even the patient and family members, agree on the discharge plan!
However, where there is conflict, particularly with my additional responsibility as the best interest decision maker, the role of the hospital social worker can be a lonely and daunting place. You have to of course be willing to continually review all of the available information and the conclusion you have drawn.
How can we make integration work? At Community Care Live an expert panel will discuss the latest evidence on how pioneering areas are overcoming challenges and achieving success in this difficult area.
But I’ve learned that when you feel you have reached the appropriate conclusion, it’s important to stand by your professional judgement, even though the pressure can be palpable. The easier option would be to follow the majority but I believe that would compromise the purpose, principles and values of social work itself.
‘Positive risk taking’
There are key principles of the Mental Capacity Act 2005 to consider, such as the least restrictive option and positive risk taking as appropriate. A point that has stayed with me from training on the act is: ‘What is the point of minimising all risks if you have no quality of life?’
In a hospital environment, I’ve found these are not often favourable approaches and there is a general tendency to over-protect patients to avoid the dreaded ‘failed discharge’. But the role of the social worker is not to make your fellow colleagues happy by agreeing to everything they recommend, or to appease demanding family members.
Our number one priority is the patient, their safety, and their quality of life. After all, no one ever became a social worker to win a popularity contest. Just remember, evidence and record everything!