In face of pressure to discharge from hospital during pandemic, social work's role is vital
Approved mental health professional Greg Slay on the pressure faced by hospital-based social workers during COVID-19
Published by Professional Social Work magazine - 30 April. Share your COVID-19 experiences here.
As the COVID-19 pandemic continues to challenge our work on a daily basis, I have been reflecting on our role in facilitating discharge from hospitals. Although there are profound differences of history, culture and principle in the health and social care systems, the different disciplines involved with hospital care are being bound together like never before as we work to deliver sequential person-centred care for whom it most matters.
A recent study of the challenges at the interface between health and social care in hospitals noted the importance of social workers being the primary contact for patients from admission through to discharge. Social workers were seen as the lead professionals for co-ordinated discharge planning interventions that help patients and their relatives to realise the outcomes sought for themselves.
However, the study also highlighted the need for social workers to undertake what are often complex assessments, made even more difficult by family dynamics, the rationing of available community resources, by others providing conflicting information and advice, and by the need to be seen as not obstructing or delaying hospital discharge.
In my own employment as a local authority manager, who has been involved in preparing detailed investigation reports as responses to complaints made through the Local Government and Social Care Ombudsman, I am acutely aware of the potential for the work of social workers to be misunderstood or misrepresented by others.
From soundings I have taken from colleagues the pressures on hospitals – both acute and mental health – do not seem to be diminishing. Some social workers are finding that getting to grips with new policies and procedures and revised Care Act criteria - all of which are being introduced to support COVID-19-related hospital discharge – is unnerving and stressful. Many new temporary service arrangements, such as seven-day working of specialist placement-finding teams, have also been initiated to managing potentially significant increases in the volume of referrals.
There is currently little certainty about the patient journey through hospital discharge because things are changing so quickly. Some social workers are poised and waiting for an unknown potential influx of work, while for others the influx has already happened.
From a mental health hospitals perspective, social workers are increasingly seeing older patients discharged from wards in order to free up space for newcomers. Aftercare planning meetings are being called with little notice - which mean that not all the relevant parties can contribute.
Some patients are then discharged immediately, often with unsafe or incomplete follow-up support plans. I have been involved in a number of these in recent weeks while working as an Approved Mental Health Professional with our local out of hours service.
On one occasion someone who had been in a mental health ward for five weeks was discharged on a Friday with no documented support plan for herself or for her carer, and was being assessed under the Mental Health Act for a possible re-admission the following Monday.
Older people discharged from mental health hospitals who need care home provision are increasingly being restricted in what is offered to them. There is a danger of shortcuts being taken in order to maximise throughput – such as placements not being in the best interests of a person with complex needs or where providers are themselves being risk adverse in whom they will agree to accept into their care.
Other people are being discharged home with nominal support from their local mental health team (support which is now largely only being provided by telephone during the pandemic). There is a then a danger of some teams viewing such telephone support of limited impact and deciding to just discharge the person from their caseload altogether. The role of social workers in holding these sorts of discussions and decisions to account is needed now more than ever.
There have also been cases of people ready to be discharged from mental health hospitals but who have tested positive for COVID-19 and so are waiting on the ward before being discharged to care placements. The main concern for social workers is that while they try very hard to ensure they find the best placement to match the person’s needs and wishes, if the wait on the ward is too long the placement offer may be lost, and then the process of finding a placement has to be restarted all over.
It seems then that the way in which social workers - and social care staff more broadly - engage with patients in hospitals during the COVID-19 crisis is compounded by additional limits on time, resources and information.
The Department of Health and Social Care’s Ethical Framework for Adult Social Care, published in March 2020, provides useful guidance for England through these dilemmas. Local professionals, such as principal social workers, are felt to be key to ensuring that it is applied to frontline practice in their areas.
The Framework, based on eight core values and principles for practice, recognises that where resources are constrained and there are specific surges in demand, it may not be possible to consider all eight areas together.
I am however confident that our ability and willingness to work within this Framework, and others like it in the devolved countries, as well as the Code of Ethics and other guidance produced by the British Association of Social Workers and practice standards published by the regulators will help us deliver effective, accountable and reflective practice in the ‘unprecedented times’ we now find ourselves.
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This article is published by Professional Social work magazine which provides a platform for a range of perspectives across the social work sector. It does not necessarily reflect the views of the British Association of Social Workers.