Annex A > Chapter 16 - Support and Counselling > Bristol City Council Social Services Department
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Bristol City Council Social Services Department
Organisation, accountability and funding
121 Dr McMullen was Principal Medical Social Worker (Teaching) (PMSW(T)) at the BRI from 1975 to 1987, and Social Work Team Manager at the BRI from 1987 to 1992.
122 In her written statement to the Inquiry she explained how changes to the structure and accountability of social services in 1974 and 1987 had affected the role of social workers, and caused a move away from their performing a role as counsellors.
123 Prior to 1974 social workers (then `Medical Social Workers') had been employed by the hospitals and paid by the health authority. In 1974 the responsibility for the management of, and payment for, social workers passed to local authorities, in this case to Avon County Council.
`Medical Social Workers are trained to support patients and families, and they form part of the treating team. It was my experience that the changes in 1974, when responsibility for payment and management of Social Workers in hospitals moved from the Health Authority to Local Government, started a process that had a far reaching impact on the counselling role of Social Workers in hospitals. Management of Social Workers became the responsibility of Social Services provided by local authorities in 1974. Many of these managers had little comprehension of the function of a hospital Social Worker. This change began the erosion of Social Workers' ability to provide counselling in hospitals. Gradually, the role of the Social Worker in a hospital became much more focussed on carrying through the legislative duties imposed on Local Authorities, with far less emphasis on counselling.' [154]
125 She also highlighted changes brought about in 1987:
`In the restructuring of 1987, Social Services Management was entirely separate from that of the hospital, there was an inevitable lack of understanding by management of the work needed to be undertaken by Social Workers in a hospital setting. Statutory functions imposed on the Social Services Department of the Local Authority recognise the work of Social Services in dealing with: adults and children at risk; identifiable social problems, for example inadequately housed people, benefits entitlement and (in co-operation with health staff) planning the patients' discharge into the community. This change in perception, which I believe was driven by the change in the statutory role of Social Workers, coincided with a greater recognition by others involved in healthcare of the role and value of counselling during the mid-1980s.' [155]
126 Dr McMullen explained that, in the 1987 restructuring, the post of PMSW(T) was abolished, and she was then appointed Team Manager for the Social Work team covering the BRI and the oncology centre, and was responsible to the local authority Social Services manager.
127 She stated that, as a result of the restructuring in 1987, although contact between team managers was maintained through informal networking, there were no structural links between the Health District and the Social Services Department and as a result social workers in different hospitals would be managed by different Social Services areas.
128 The Social Work team at the BRI reported to Bristol North Social Services, and the team at the BRHSC reported to Bristol Central. The General Hospital team reported to Bristol South Social Services: [156]
`At this period, it was clear that Social Services Headquarters management did not value hospital social work nor the co-operation with health staff that was inherent in it. There was therefore continuous pressure to reduce the number of social workers in the team and to reorganise work along lines that more closely fitted a locality team model rather than a health one. My task therefore seemed to be to protect the essential nature of hospital-based work while changing that which could be changed without too much damage. There was much greater understanding and value given to the role of the hospital social worker by staff and management within the hospital than there was from social services management.` [157]
`My work was structurally separated from the Social Work Team manager at the Bristol Children's Hospital ...' [158]
129 Mr MacIntosh, Social Worker at the BRI throughout the period of the Inquiry's Terms of Reference, and Acting Team Manager at the Social Work Department from January 1997 to November 1998, also commented on the changes in the role of the hospital social worker. He stated that until 1990/91 social workers within the BRI Social Work Team were employed as generic social workers. Following the Children Act 1989 and the NHS and Community Care Act 1990 it was recognised that this was no longer viable: [159]
`The expectations of Social Workers in hospital to provide medical counselling as a general part of their work with individuals was historically established and there was a general expectation that this continued until the changes had started to take place in the late 1980s. Social Workers were at that time funded by Avon County Council.' [160]
`My recollection is that there were considerable managerial, political and financial constraints on providing Social Work staff to meet needs related to healthcare treatments (both locally and nationally). I believe that the inability of the Social Work Team in the BRI to take on additional work created by an expanding service of Cardiac Surgery (as with other areas of specialised clinical practice) resulted in prioritisation of work towards statutory duties and responsibilities only. These constraints continue to this day.' [161]
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Footnotes
[154] WIT 0487 0008 Dr McMullen
[155] WIT 0487 0008 Dr McMullen
[156] WIT 0487 0009 Dr McMullen
[157] WIT 0487 0004 Dr McMullen
[158] WIT 0487 0006 Dr McMullen
[159] WIT 0401 0002 Mr MacIntosh
[160] WIT 0401 0002 Mr MacIntosh
[161] WIT 0401 0002 - 0003 Mr MacIntosh