Hospital social workers should be reinstated onto wards to support people to achieve better outcomes on discharge, amid the current severe pressures on the NHS and social care.
That was the message today from the Adult Principal Social Worker Network in an open letter to health and social care secretary Steve Barclay.
The letter, which has been backed by the British Association of Social Workers (BASW) England, warned that a lack of social work assessments prior to discharge was leading to people ending up in the wrong place, reduced independence and lower quality of life.
The PSW network’s intervention comes on the back of the number of medically fit people awaiting discharge reaching 14,000 in early January – the highest level on record – due to a lack of social care, community health and other services to support them on their return home.
In an effort to clear beds, the government has provided £700m from December 2022 until March 2023, mostly for the NHS, though chiefly to fund social care services, with the latest £200m tranche of this – announced last week – reserved for care home provision.
Risks of ‘poor or potentially illegal practice
This has prompted criticism from other social care leaders, with the Association of Directors of Adult Social Services (ADASS) warning this week that it risked “poor or potentially illegal practice” through people ending up permanently placed in care homes without informed consent.
The PSW Network raised similar concerns in its letter, saying people were being discharged to care homes when they recovered best at home, supported by their networks and communities.
“We are concerned that people leaving hospital are ending up in the wrong places, with the wrong support, away from the people and things that are important to them which means they are at increased risk of a slower recovery and a potential unnecessary return to hospital,” network co-chairs Hannah Scaife and Sarah Range told Barclay.
“We know that people are able to remain independent for longer and have a better quality of life when they can return to their own homes.”
Hospital social work assessments ‘key to right outcomes’
On behalf of the network, Scaife and Range wrote that a social work assessment in hospital was “key to ensuring that a person gets to the right place for them, with the support that they need”.
However, hospital social work assessments have become much less prevalent since the national rollout of the discharge to assess (D2A) model in 2020, at the start of the pandemic.
The model is designed to ensure people are discharged when medically fit, mostly to their own homes, though in some cases to bed-based services, where any short-term needs will be met and their independence maximised pending an assessment of any longer-term social care needs.
Department of Health and Social Care (DHSC) guidance on discharge states that hospital social workers have a “vital role as members of a multi-disciplinary team, ensuring a person-centred and strengths-based approach is adopted during pre-admission, hospital stays and planned safe discharge”. This was particularly so for people with complex social circumstances.
The DHSC has also said that social workers and other social care staff should carry out “limited assessments” on wards prior to discharge.
Impact of reduced social work involvement
However, the PSW network’s letter stated: “We know that the absence of social work assessments is increasing stress for care providers who have inadequate information for their care plans, causing trauma for carers and families who are not involved as they should be in decision-making and who end up picking up the pieces from our broken system.”
For BASW England, professional officer Denise Monks said: “BASW wholeheartedly agrees that social workers in hospitals needs to be revived.
“Historically, social workers based in hospitals helped prevent people being readmitted to hospital by timely interventions to review existing care packages or mobilise support from families and others in the person’s network, meaning a person can be safe to return home from hospital directly from A&E to receive community health.
“We need to get back to this multi-disciplined approach and sharing of knowledge to avoid overuse of the medical model. Quite simply, social workers need to be able to work with people before they are discharged from hospital and assess their social care needs going forward ensuring the move is very much ‘person centred’ and not one size fits all.”
Practitioners on wards ‘essential’
For ADASS, chief executive Cathie Williams said: “Social workers in hospitals are essential to ensure that, at the very least, safeguarding and mental capacity issues are addressed properly and to ensure that discussions are held about the options and implications of different places for care and if needed longer term time for assessment and planning.
“Without social workers in hospital to do this, there is a high risk that too many people will be persuaded, deceived or led to believe there is no option but to move into residential care where there are shortages for care at home. There is evidence that such discussions – setting out options and listening to what matters to people – result in less or less expensive care options.”
She added that D2A could work so long as there was “sufficient staffing capacity in local systems for people to be discharged to recover, rehabilitate, and then, if longer term care is needed, to talk with social workers to assess and plan for their futures, weighing up the benefits, risks and costs of different options”.
Leaders urge recovery focus
The focus of the PSW network’s letter was reflected in a paper published yesterday by ADASS, the Local Government Association and the NHS Confederation, which represents health leaders.
This called on the government to fund the full implementation of a “recovery model” in health and social care, designed to maximise independence and quality of life and thereby prevent hospital admissions.
This stated that adult social care and NHS staff should “jointly review all people being discharged from hospital to make sure that they have the information to make informed choices about the risks and benefits of different options and ensure that any ongoing treatment, care and support is appropriate, with the aim of regaining independence, confidence and connectedness”.
The DHSC has been approached for comment.