‘Are we trying to “fix” the child?’: social work in an NHS team

Bringing her social worker’s perspective to a clinical setting forces Rachel Sempija to reflect on anti-oppressive practice

Joining an NHS team as a social worker felt a bit like returning to the Teesside council estate I grew up in with my new Ugandan surname. It provokes varying degrees of discomfort, interest and some inappropriate jokes at times but I have to admit, I quite enjoy it.

Being a social worker in an institution that does not employ social workers means that I am referred to officially as “a social worker by background” and a “clinician” by role.

My contract says I am a nurse because there was no option for my professional history in the dropdown menu.

I am one of 26 social workers among the 4,500 nurses at Tees, Esk and Wear Valleys NHS Trust.

Most of us 26 are in the child and adolescent mental health service (CAMHS). Perhaps this is because there is not a clear route to mental health services for children in social work – there is no equivalent of the approved mental health practitioner (AMHP) training in adults’ services, for example. And integrated NHS/local authority therapeutic teams based in children’s services (like my last job) are few and far between.


It was a risky leap moving to CAMHS, but for me, becoming a social worker in the first place was a bit like that. When my parents became overnight ‘extended family carers’ overnight, the social worker who supported us to understand and nurture the little boy we cared for as he processed his experiences of abuse was skilled, inspiring and radical in her approach. It was that experience, and her way of being a professional, that led me to rethink my career plans and eventually train as a social worker.

Moving to the NHS was risky because I was leaving a permanent post of six years for a 12-month temporary role. My working week is longer, over more unsociable hours and I have less annual leave. I lost the low interest loan for my car and have to drive further but we can’t move because I can’t give the bank assurance of where I will be working once this contract ends.

When I left, I also just missed the progression panel, which would have lifted me to the top of the current band I am in. There are significantly fewer opportunities for me in the NHS with my training background as most adverts ask for nurses and so there is also a band six glass ceiling.

However, I love this job and I am resolutely staying in the NHS, in children’s mental health.

What’s surprising to me is that the social worker’s perspective is not more readily embraced in children’s mental health teams. A medical view of children as dependent beings is contained in the language. We ‘nurse’ children when we breastfeed them and then when they are physically ill, they are nursed back to health – ‘fixed’.

In mental health, ‘problems’ are determined by a group of psychologists and psychiatrists who discuss which conditions will be listed in the ICD-10 or DSM. The difficulty can then be treated. In reality, most of us will have characteristics on the continuum of some of these conditions at one time or another depending on the demands on us. That is to say, our behaviours are contingent on the environment we exist in.

A more radical view

Radical strands of social work draw on ideas from social constructionism and post-modernism to call into question this idea that professionals can repair people in isolation for their environments.

Symptoms of behavioural difficulty often have roots in the systems young people are a part of – families, friends, schools, communities and so on. Symptoms are just that, the visible tips of the icebergs.

For example, I see a young person fortnightly to support her to be less anxious. This would be simpler if her parents did not demand straight As in maths and science. Her talents and interest are in creative writing. I am working to support the parents let go of their anxieties; there is not much to ‘fix’ within the child.

In my view, we should seek to understand the lived experience of young people. Acting to change a person’s thoughts and feelings so they are more in tune with unhelpful home, school or community factors is oppressive. This is where I welcome social work’s explicitness about the tensions around ensuring practice is anti-oppressive.


Wherever we work, there is always a Big Authority or Big Trust watching us. Whether in team meetings, individual performance reviews on centrally driven targets, the public sector needs to be accountable.

Yet reducing waiting lists by allocating a targeted number of referrals a month means that caseloads are huge. Simply allocating a young person to a worker does not magically create the additional time in the worker’s week to see them. They will have to be (a) patient while work with others is completed – until we can give a service to the ‘service user’. Some young people wait so long, they find other ways of coping – only if they are more risky are they moved up the list.

Naming and shaming

Embedding a culture of naming and shaming workers for failing to meet targets seems counterintuitive. It reminds me of my work of the young person struggling with algebra to make her parents less anxious about what the neighbours might think.

It may help if NHS teams introduce some of the changes going on in children’s social work more broadly. In my previous local authority role, I was my team’s representative at Principal Social Worker meetings. This stepping stone between the frontline and senior management makes organisations healthier and makes accountability more meaningful.

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2 Responses to ‘Are we trying to “fix” the child?’: social work in an NHS team

  1. Planet Autism November 4, 2015 at 5:17 pm #

    “I see a young person fortnightly to support her to be less anxious. This would be simpler if her parents did not demand straight As in maths and science.”

    Considering social workers are working with courts removing children for the potential for future emotional harm, I am utterly amazed that the parents have not been accused of causing emotional harm to their child, such is the frenzy in children’s social care across the UK right now.

    Bear in mind there is massive pressure from society on children, schools play a huge role too. It isn’t necessarily from within the family that behavioural and emotional problems are caused in children.

  2. Graham November 11, 2015 at 2:41 pm #

    I couldn’t agree more. The medical model on it’s own is far too focused on the diagnosis and treatment of a sick child rather than looking at the wider context. My family therapist wife is clear that the problems of the children she works with overwhelmingly originate from within the family or wider social system, few if any originate from within the child itself. Although the symptoms of a difficult family dynamic may become apparent in the child, ‘treatment’ needs to include the whole family.