Hospital social work and community care: the practitioners' view.
This paper presents the findings of an exploratory research study which considers the effect of organisational change on social work practice in hospitals in four local authorities in England. Its aims were (1) to obtain the views of hospital social workers and their managers about the effect of implementing the NHS (National Health Service) and Community Care Act of 1990 and policies for Care in the Community on the practice of social work and (2) to elicit issues of concern to form the basis of a national study. Semi-structured interviews were carried out in hospital social work departments which were providing a service to adults with health needs. Interviews with a representative sample of 85 workers and 36 managers (including Assistant Directors and Principal Training Officers) in 11 hospitals were held between June-December 1993, three months after the introduction of the policies. The interviews were tape-recorded and transcribed. A questionnaire provided some quantitative data, and additional information was obtained through non-participant observation at team meetings. The interviews covered four topic areas: the nature of social work in hospitals; the changes introduced by implementing the legislation; the management of that change; and the effect of the new policies on practice. Results show an increase in the volume of referrals particularly in assessment for nursing home care; and an overwhelming amount of administrative work to process the new procedures for providing community care. Most relates to filling in forms, duplication of assessments and repetitive bureaucracy. Workers struggle to meet their expectation of professional practice with organisational demands. The discussion centres on three issues raised by practitioners; the changing nature of social work due to the alternative models of service being imposed by local authorities; the lack of consultation and involvement by management of the frontline workers in the management of this change; the dissonance felt by hardworking and committed practitioners to whom the increasing paper work is yet another obstacle to user involvement. This may have clear implications for management, for the degree of stress and perceived pressure resulting from these organisational changes is counterproductive to job satisfaction. If the reforms are not to be undermined, they need proactive management. This requires a sensitivity to workers' needs, investment in training and working together to integrate the care management role into social work practice.