Using the guidance

This guidance provides a professional risk framework to prepare for face to face social work in hospitals with adult patients, families or carers during Covid-19.  It is not a comprehensive guide to hospital social work. Its aim is limited to planning for and managing risk during Covid-19 – whether with adults who are Covid-19 positive, negative or infection status unknown. It may be transferable to social work with children and young people in hospital.

BASW, your professional body, recommends this approach based on best available evidence, latest public health guidance, practice experience and expertise.

Key ethical principles underpinning this guidance are:

  • Social workers should be able to exercise professional judgment in undertaking social work in hospitals throughout Covid-19 pandemic
  • Social workers shouldn’t be required to undertake face to face hospital social work if there’s a suitable remote option and/or if infection risk mitigation - including suitable personal protective equipment (PPE) and guidance in its use - isn’t available
  • Social workers must not be stopped from carrying out a hospital visit/activity if there’s a clear legal or practice reason to do so (e.g. a safeguarding risk or care planning requirement)
  • Health partners should facilitate social work visits/activities in hospitals when the social worker judges them necessary.  

Please use the guidance to:

  • Guide and inform your practice
  • Request appropriate support and guidance from employers and hospitals/NHS
  • Raise professional concerns and questions about local practice or guidance with your employer, health and safety representative, trade union and BASW.

This guidance does not:

  • Replace public health national (official) guidance  or regulatory or employer guidance 
  • Cover use and decision making related to the Mental Capacity or Mental Health Act
  • Cover social care or health workers who are providing hands-on personal care
  • Cover social workers working in other settings. BASW is issuing guidance for contexts – check the website for updates.
  • Cover risks associated with use of public transport – please follow public health guidance
  • Advise on the detail of statutory duties – this is for statutory bodies to advise based on law, policy and good practice.

Understanding of health and safety throughout this pandemic is developing. Practitioners should continue to check and follow public health guidance at https://www.gov.uk/coronavirus.  Practitioners should also be aware of the latest information from the regulator and their employer.

Standard statement on Personal Protective Equipment (PPE)

There is no specific public health guidance for the use of PPE by social workers in hospitals or other settings. This standard guidance will be updated as necessary.  

However, there is public health guidance of relevance to social workers. For hospital setting. Please see the public health/ government table of recommended use of PPE for ‘healthcare workers by secondary clinical context’.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879107/T1_poster_Recommended_PPE_for_healthcare_workers_by_secondary_care_clinical_context.pdf

Social workers undertaking hospital-based work should review this table to match to their situation and review other tables in the series for other settings (e.g. PPE for primary, outpatient and community care settings. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.pdf

Always check for updates on guidance for health and care workers from Public Health - available here https://www.gov.uk/government/organisations/public-health-england

Appropriate use of PPE protects both staff and people using services.

The ongoing lack/insufficiency of PPE for social workers at time of writing is being raised with government by BASW.

 

Hospital social work with adults - practice guide during Covid-19

1.  Planning a face to face encounter with a hospital adult patient, family or carer

Identify if the purpose of the face to face encounter is essential at this time.

  • Check local (e.g. employer) guidance and prioritisation of work
  • Check if there is a legal /statutory requirement. 
  • Check (e.g. by telephone) if the person (or their family / carer where appropriate) needs/wants to see you face to face and explain the possible risks of meeting
  • Clarify aim, likely outcomes and subsequent actions.

Identify whether the purpose of the meeting could be achieved without a face to face social worker encounter.

  • This could include:
    • Professionals/carers already in contact with the person holding the conversation
    • Use of remote technology, telephone contact or written correspondence
  • Check with your local organisation arrangements and guidance.

 

For multi-professional visits

 Liaise with other agencies and professionals and consider:

  • How a ‘team’ approach can help you or someone else to undertake the conversation/action effectively
  • Who will do what, who will be in what proximity to the person and how long the visit will take
  • What Personal Protective Equipment (PPE) each person might use
  • Ensure social work ethics and values of respect, appropriate communication and rapport are upheld in multi-professional teamwork 
  • Ensure the person and/or their family or carer understands the reason for - and can express their wishes with regard to - the multi-professional visit and how it will run

 

Evaluate the level of the known infection risk for the person you are to work with and their location.

  • Check with the hospital about the person’s health/Covid-19 status.
  • Check health/Covid-19 status of others that you may come into contact with en route in and out/on the ward
  • Check whether social distancing (keeping at least 2 metres apart) will be possible in areas you go through,
  • If there are known risks of infection or higher risks to health that indicate the person should not have visitors, seek advice from your line manager and re-evaluate

Identify the arrangements the hospital has in place to minimise infection as far as is reasonably possible and ensure you follow/build these into your risk plan

Ensure you have sufficient training and information in infection risk planning and management relevant to the Covid-19 pandemic before undertaking a work in a hospital during the pandemic.

 

If the visit/activity in the hospital is necessary and must be undertaken, make a risk plan for your visit to cover:

  • Minimising infection risk in travelling to and/or parking at the hospital e.g. travel alone in a car and ensure not to cross-contaminate the car upon departure.
  • Minimising infection risk in entering and exiting the hospital e.g. avoiding crowded entrances and touching surfaces where possible
  • Going only to areas where Covid-19 is not currently known to be present where possible
  • Following infection control protocols and avoiding cross-contamination between areas of the hospital e.g. hand washing, sanitisers, designated areas, distancing from entry to exit
  • Minimising areas you will visit and the time you will spend
  • Following hospital hand washing and hygiene precautions on from access to exit
  • Following all public health guidance around hygiene, clothing, Personal Protective Equipment, distancing etc.
  • Remaining at least 2 metres from all people at all times including the person/s you are visiting unless using appropriate PPE in a suitable manner.
  • Disposal of any Personal Protective Equipment at the end of the visit/activity

This list is not exhaustive, and all social workers must make personal and specific judgements about risk and approach with support from their organisation. The list cannot take account of (for instance):

  • Particular features of the hospital environment or the nature of the visit/activity e.g. high risk on unwanted touch by the person or their family/carers
  • Relevant hospital and employer guidance and protocols

Review your plan with your team manager or colleagues (e.g. on duty) to ensure it is practical and ethical, and that risks will be reasonably managed.  Confirm the visit/activity should go ahead.

Confirm that any and all Personal Protective Equipment advised for your face to face meeting is available and accessible.

Ensure that the person (and/or the family or carer/s) you are meeting with is informed in advance (as far as possible) on the purpose, content and expectations for the meeting/visit.         

  • Ask for them to be briefed by a member of their hospital care team.
  • Consider sending information to them in advance including in easy read or other formats if required. 
    • Where a person may lack capacity (as defined in the Mental Capacity legislation depending on country), ensure that a person’s best interests and support needs are considered by those who are responsible or have relevant legal authority to decide on their behalf. 

 

Talking to patients, families and carers about risk precautions during Covid-19

Maintaining social distance of 2 metres from patients, families or carers and using face and body covering PPE may feel counter to the relationship and rapport-based ethos of much social work. Explaining fully before and during the meeting the reasons - in a format or language accessible to the person/s - is essential. This may include written, visual and spoken explanation.

Social workers should prepare for this carefully including explaining the reasons to person/s directly or via a family, member, carer or advocate. 

If a person lacks mental capacity to understand this or any other information related to the social work activity, the provisions of the Mental Capacity Act and Code of Practice apply (unchanged by the Coronavirus Act to adults). The person’s understanding and decision making should be supported and optimised. Best interest decision making and deprivation of liberty assessments under the Mental Capacity Act  should be used as necessary.

 

2.  Immediately before the meeting/visit

 

  • Again, weigh up if the visit/activity is necessary at this time or if an alternative would achieve your aims/responsibilities. Check with your manager if necessary.
  • Check your risk plan and ensure you can action all parts.
  • Check the equipment (PPE) you will need during the meeting/visit, how you will access this and ensure you know how to use it (or who will assist you with this).
  • Check nothing substantive has changed that would affect your risk plan (e.g. the person has been moved to another ward; their Covid-19 status has changed)

 

3.  During the visit

Follow relevant public health, employer and hospital guidance during the visit. Remember this includes but is not limited to:

  • Following your own risk plan
  • Following guidance on hand washing and hygiene throughout
  • Following guidance on minimising potential contact with the virus, for example
  • minimise the surfaces that you touch, do not put your personal items down on any surfaces, try not to touch your face, ask for the room to be ventilated (e.g. through an open window and door), keep 2 metres or more away from other people and follow any other public health guidance about minimising infection.

Keep the visit focused and as concise as possible. If you consider that the risks are not proportionate or are not being managed, explain why you need to end the visit and how you will plan to follow up.

 

4.  After the visit

Follow relevant public health guidance immediately after the visit.

  • Follow guidance on hand washing and hygiene. e.g. removing and laundering your own clothes
  • Follow guidance on disposal of any Personal Protective Equipment.
  • Follow guidance on sanitising equipment that you have brought out of the hospital, for example by using disinfectant wipes including phones, laptops etc. 
  • Follow guidance on removing and washing clothing.
  • Wash your hands before going into another building for 20 seconds with soap in line with public health guidance or sanitise them.

Inform the hospital and/or your employer organisation of any concerns or risks that you have identified.

5.  Follow up to the visit 

Report back to your colleagues, or line manager about the visit.  Identify any learning, risks, concerns or good practice.

  • Your employer  should ensure there is an option for an immediate debrief if needed
  • Share any learning that can support practice and your organisation. 

Record the visit.

  • Include any amendments to practice that were necessary due to the pandemic. 
  • Record any information that is needed to support practice and your organisation. 
  • Make sure you provide any relevant guidance for others who may be visiting the hospital, this person or planning a face to face meeting at a future date.
  • Record any decisions made including information considered, evidence base and rationale for decision(s) made.

Seek support for any professional or personal concerns.  

 

Support for practice

Coronavirus guidance

https://www.gov.uk/coronavirus

BASW information and guidance around Covid-19

https://www.basw.co.uk/coronaviruscovid-19-basw-updates   

You can direct questions or concerns to BASW by contacting us

https://www.basw.co.uk/contact   

BASW Survey for feedback on practice during Covid-19 https://www.basw.co.uk/media/news/2020/mar/social-work-during-coronavirus-covid-19ongoing-survey   

BASW virtual activities to provide peer support and learning can be found here https://www.basw.co.uk/events   

Professional practice guidance for hospital social work with adults during Covid-19 Pandemic

BASW Published 17 April 2020