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.”
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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.
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To some extent, I agree, but the real problem is the dire lack of sufficient social care, mainly due to the long-standing lack of funding for social care which means the pay rate for social care workers is so low as to not encourage more to enter the care profession. But it is not just the pay rate but the whole employment terms and conditions for care workers. This is coupled with the immigration restrictions which are not enabling non-UK workers to come to the UK to enter the care profession either short-term or long-term.
This is all down to current Government policy although the dire funding covers so many years as no government has funded social care sufficiently, which has led to this current crisis not only in social care but also in the NHS.
The current amounts of funding to try to solve the NHS bed shortages due to patients not being able to be discharged are way too little and way too late, for to solve, to any degree, it is £billions required and not the £millions currently being offered.
One may say the country can’t afford it, but in reality, it has to for any hope of saving both social care and the NHS for one can’t exist without the other.
I totally agree with this assertion as very often people are discharged home or to a care home without proper assessments under the Care Act 2014. This has led to many failed discharges which have in turn lead to an increase in the amount of safeguards being raised following unsafe discharges from the Hospitals. Unsafe discharges have also led to more strain on meagre NHS Resources and increased caseload on already poorly staffed Social Care Teams.
Unmet need, unmet need, unmet need. Until we accurately record and measure where we meet need, but not in the best way, we will continue down this path. Social work on wards is not just best practice, it’s essential. In my experience, not many ward staff fully understand mental capacity and their legal responsibilities to the person.
Having worked in a Hospital Social Care Team since 2005, I have seen many changes to the way discharges occur. Being Ward based pre-covid worked well. However the NHS have always fought against the length of time it took our services to source appropriate care.
On the basis of the current turn-over of patients being discharged (inappropriately or otherwise), it is unlikely the NHS and central Government will allow a return to Ward based assessments.
The NHS will always be a priority for the voting public, whereas Social Care will always be the ‘Second Class Citizen’, falling in line with the machinations of political Spin Doctors.
It’s only when the public find themselves in a position to actually need social care that they realise how awful the whole process is.
Up to that point, people tend to believe the only use for Local Authorities is to fill potholes…….
This is all very accurate – paying peanuts will never work in social care. I have been a manager in social care and a QSW and find, to date, my local councils are so rigid and blinkered they are happy to employ agency staff ( and let them take the rap when something goes wrong) that they will not offer me work even though I have approached them directly. Sadly I suspect this is ageism and disabled prejudice – at one ‘interview’ I was told I could not access a ground floor office or have a laptop although I couldn’t climb the stairs, and at another virtual interview told I could use the goods lift. The interviewers are still in post. Reasonable adjustments don’t exist if agency, and direct host applications don’t get a reply, yet I was added to the list in the pandemic without consultation…. Enough said.
I worked in a Hospital Discharge Team for 21 years prior to my retirement. This was attached to a busy London Hospital which also had Discharge Coordinators (paid by NHS Trust) Hospital Social Workers also attended weekly MDMs where each patient was discussed and possible discharge date and care needs. Some wards/consultants did not like the fact that we insisted on a full assessment of need prior to discharge and tried to discharge without support. At the time of my retirement – hospital discharge team could put in up to 21 hours pw care package with a review at 6 weeks to adjust if necessary hours given. I kept in touch with my colleagues and asked how they fared during the pandemic to be told that they were not allowed to do assessments and patients were discharged home without proper care or sent to car homes without being cleared for covid.
With the reduced funding to local authorities by the government – all care packages now had to be approved of by a panel which has contributed to delays. Our team worked a 7 day week (with extra staff working Friday – Mondays to complete face to face assessments). Local Authorities mainly contract out care services and obviously choose agencies which appear to be ‘cheaper’. The result being that agencies pay their staff a pittance so that they can rake in a small profit. With Brexit, many good workers in care homes and agencies returned to their country of origin which has lead to shortages. Answer can only be that more money is needed by LA so that they can purchase affordable and good quality care.
I worked in a hospital discharge team for 6 years before covid arrived and I now work in the discharge to assess team. When working on the wards, most people returned home with care or appropriate support. Now we see nurses (discharge co ordinators) responsible for discharge assessments, there are many more people going to care homes for silly reasons. The nurses do not have proper knowledge of mental capacity, their capacity assessments are shocking. They hardly include the views of family even when they have POA, sometimes they do not even include the adults views in the assessment. They are focused on discharges at any cost. We have noticed a huge increase in failed discharges! Lack of equipment, wrong levels of care or no care at all. Very sad to see so I would love to see social workers back on the wards!
I’m not sure if those suggesting full return of social workers in the hospital are aware of the tasks and the numbers of staff require to make very efficient.
From my experience there is no one being discharged without mental capacity assessment from hospital
Discharge to assess, gives time for customers at time to recover a bit at home before full assessment takes place may be within 3 or more weeks. In long run social services find a bit of saving
I’m worried if those who sit and just read assessments and support plans when done do not know the exact work pressure