In the eye of the winter storm

Published by Professional Social Work magazine, 16 February, 2023

As manager of a hospital discharge to assess team covering four acute/community hospitals in Essex, Suzanne has just been through the busiest time of the year. Horror stories of winter bed blocking dominated headlines over Christmas and well into the New Year. The crisis was also the subject of fierce political debate.

In Essex, planning for winter begins in August. The county has developed a ‘home first’ ethos focused on getting people home and supported as quickly as possible.

Patients are assessed on the ward and when “medically optimised” referred to Suzanne’s team to follow up with a community-based Care Act assessment   

This is along one of two pathways. Pathway one is for people whose care and support needs can be met at home.

The team works with Essex Cares Limited (ECL), a franchised provider delivering carers, physiotherapists and occupational health therapists to provide reablement support people in this pathway.

If the patient’s needs are not currently suitable for reablement or there is no suitable provision in their area, they are referred to Alternative Reablement Care (ARC).

“It doesn’t mean they have lost the opportunity [for reablement], it just means we have to be really clear on who can benefit from that reablement service and who will be unlikely to,” says Suzanne.

“Otherwise, we would see that people who really have the potential to improve miss that opportunity.”

Pathway one patients that do not meet eligibility threshold for care under the Care Act – on average about a third – will be signposted to relevant services. This might be, for example, organisations providing support with issues such as managing drugs and alcohol or finances.

Pathway two is into residential care when a person has been assessed as unsafe to go home.

“It could be their needs have increased - they might now be non-weight bearing,” says Suzanne. “It might be they have had a cognitive decline and home isn’t safe or it might be for a safeguarding reason.

“At that stage we would allocate one of our workers in my team and follow them up within seven days.”

On average, patients referred to Suzanne’s team are discharged the next day. Essex County Council and the NHS jointly fund a bridging service to temporarily step in if ECL or ARC support cannot start straight away.

The process is one that has been honed over several years and requires collaboration between health and social care.

“It wasn’t always like that – go back four or five years and it was very different: it would be ‘this is health’s role, this is social care’s role’,” says Suzanne.

“When we had a restructure in 2018 it set out roles and responsibilities more clearly.

“We still have our challenges but we are more aligned. There is always that pushback – social care saying the needs of this person are over and above what social care can meet, and health saying it doesn’t meet the criteria for continuing health care funding.

“We are all aware of our budgets and unfortunately sometimes individuals fall in between. But this is where the really good discussions happen. Sometimes we say, ‘Okay, we will support this person,’ and move forward and health do the same.”

Key to success is developing trusting relationships between social care and health staff, says Suzanne.

“We have to realise and respect that health aren’t social workers and social workers aren’t health. So it is about valuing the worth of each professional and how combined we can meet the needs and outcomes better for the people using the service.”

Wrangles over budgets, no matter how well handled, nevertheless illustrate the division that has long dogged health and social care.

Suzanne adds: “I have been in social work for 26 years and I am always of the view that until the government give health and social care a joint budget there is always going to be barriers.”

Reducing bureaucracy would also help, says Suzanne.

“I understand the importance of paperwork but it should be more streamlined. And the government needs to reward health and social care professionals and actually see what we do.”

Despite the pressures, Suzanne remains passionate about her work – and social work in general.

“It is a role I love, it is varied, it is never ever dull and I am incredibly proud of my team and social work as a profession.  I couldn’t ask my team to work any harder or be any more dedicated than they are.

“The day that I get up and I have no motivation is the day I have to leave and go and do something else.”

She recently listened to a podcast hosted by former Labour leader Ed Miliband. In it, BASW’s chief executive Ruth Allen was interviewed about social work.

“It talked about the public perception of what social workers do,” says Suzanne.

“Nobody really knows. If you ask what does a doctor do, what does a nurse do, what does a teacher do, the general public will have an educated guess.

“But if you ask what does a social worker do, they will either say ‘remove children’ or intervene where they are not wanted.”

Social work’s complexity is partly what makes it hard to explain, but Suzanne offers a neat description: “I think we are a jack of all trades and a master of people. We are in the people business. You have to be a chameleon.”

She gives some examples from her 26 years of practice. There’s the man with dementia who suddenly developed a love of walking, much to the worry of his wife who believed he needed to go into a care home.

“We got him a GPS tracker and some high vis stripes for his jacket,” says Suzanne. “We liaised with the care provider and his plan included having a carer walk with him three times a day. We got him involved with the local ramblers.

“He stayed at home for an extra 18 months. I think he would have died by now without that.”

Then there’s the mother receiving intense end of life care whose dying wish was to see her son get married.

“She wanted to go to the wedding but had 24-hour care and support needs. So we funded 24-hour live-in care in the hotel for two days.

“Sadly she died shortly after, but it’s times like that when you have to say regardless of whose responsibility it is, let’s get on and do what’s needed.”

Another time she recalls a man who was rushed into hospital creating a problem for his wife, for whom he was the main carer.

“The care agency couldn’t lock the front door to the house because he had the key. So we went into the hospital to find the husband to get the key to secure the property.

“That doesn’t sit anywhere in our role but it was something that needed an immediate response.”

Such examples illustrate the helpful, enabling side of social work the public don’t always hear about. Enabling is a word Suzanne uses often. As is “empowering”.

“I am very much invested in working with adults who are living with cognitive impairment and dementia,” she says.

“Advocating for people and being their voice because as soon as you see dementia it almost like getting a rubber and rubbing that person out to a lot of people.

“By no means should dementia mean a patient hasn’t got a voice but sometimes you need to be that soapbox for them.

“That is something we see every day. The daughter who doesn’t think her mum can leave hospital, for example – but what does the mother want? She wants to go home, so let’s look at that as a starting point.

“If I am that advocate for one person who may not have been heard or seen, that is what it is about.”