Case Study: Medical Social Worker - Amrat

What do you do?

I work purely with adults: 18 and over. Usually my client base is elderly
people. What I do, basically is facilitate hospital discharges by following
community care legislation. This is carried out mainly by screening referrals
given to us either by families, the hospital, consultants or the nursing staff.

I meet with the patient (and their family) and medical professionals, so I can
assess what their social care needs are. If relevant, I set up services such as
homecare, residential care or nursing home placement.

I cover two medical wards and a rehabilitation ward. Other social workers cover, for example, the orthopaedic ward
or the renal ward. So we all cover different areas.

What is your background?

I grew up in this area. My mother died in this hospital in the renal ward when I was 15.

It would have been useful to us as a family to have had a social worker - somebody who was not part of the family -
to assist us in the change in our circumstance. It was then that I decided that I wanted to go into the social work
profession, although it took me a few years to get into it.

I did a diploma in social work, which was my second qualification. I had worked in computers for about ten years. I
left that to go and do some voluntary work abroad, which took about three years to complete. It was after that that I
took the social work diploma.

Since qualifying as a social worker I've spent a couple of years working in two different boroughs as a community
social worker. I spent two years working as a GP-attached social worker, where I was based at a GP's surgery.

I applied to this hospital specifically because my mother was here years ago, and I felt that this was the place where I
would feel most comfortable.

What characteristics do you need to be successful in your job?

In this job there's a lot of communication involved, both written and spoken. Hospital-based social workers meet in
multi-discipline groups, where my input is just as essential as a consultant's or a nurse's in terms of a person's social
care needs.

You need to be a team player, not only within the multi-discipline teams, but within the social work team as well.

Good time management is essential. People are relying on you to meet them when you say you are going to.
Organising my own workload is an important part of my work. I need to re-prioritise my workload on a regular basis.

Knowledge is essential. You need knowledge of the Community Care Act, which is what we are guided by in this job.

Nowadays, financial awareness is increasingly important. You need to know about the benefits that people can claim:
attendance allowance, income support, carers' allowance - so knowledge of a lot of financial information is useful.

Also useful is general knowledge of people's lifestyles. You should know about the community you work in. At this
hospital we have people from all different backgrounds and cultures.

What other jobs could you do using the skills from this job?
There are quite a few other jobs I could consider. One of these would be to transfer my skills to a community-based
social work team. This could involve working with people with disability, or addressing mental health needs, or
working with people with learning difficulties.

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 Also, in the voluntary sector there's a lot of development work going on for people within the community who have
specific needs.

I have a diploma in social work, which is quite a desirable qualification to have. It can open up doors - even for
working overseas, perhaps in the voluntary sector or specifically as a social worker.

In the private sector I could possibly apply to be a manager or a deputy manager of a residential home or a nursing
home, depending on the skills that they want and the experience that I have.

What changes will there be in the future?

There are always a lot of changes occurring. That's mainly due to the legislation that the government brings in.
Legislation changes virtually with every new government and virtually every year. So a lot of my role is governed by
that.

Also, there is talk of working very closely with the health service. I think that that will change my role. It also depends
on what happens with having private sector involvement in public sector work. Again, that might have implications on
my work.

There's a lot of communication that needs to take place, and I think that technology can make that better. We (the
social workers at the hospital) take referrals verbally, but within the hospital itself referrals are sent by computer. But
our computer systems aren't linked with theirs.

If eventually the two systems were linked, then we'd have better communication with the hospital staff, and also with
GPs and other services in the community.

We use computers a lot for writing up our assessments, which is useful for us because sometimes we're involved in a
person's life for a number of years. It's useful to have knowledge of their background and assessment on a computer
system, where it's easily accessible.

What are the biggest challenges in your job?

People have different ideas of what a social worker does. It may be because people only approach a social worker
when there is a need for one. At that point it becomes a challenge to educate them in what social workers really do.

Prioritising my workload is a huge challenge. Things can change overnight. So I often have to re-jig my workload to fit
everything in.

Funding and financial issues are also a big challenge, especially when people go into care, because legislation is
changing all the time. People aren't always aware of what could be available to them.

There's a huge diversity in culture in the local area. It can be a challenge making sure that you address each culture
and are finding appropriate services for everyone.

Also, working with the Health Authority can be challenging because they have their own method of working and we
have our method of working. Combining those methods in order to meet a patient's needs can sometimes be
challenging.

Are there many opportunities to enter this career?

I don't think it's that difficult to get jobs in social work. Although, having said that it is quite a challenge being a social
worker.

I would say to anyone wanting to be a social worker to look at their own social set-up and support system; not
because the job is very stressful, but it is useful to have support outside of work because it can be stressful
sometimes.

There are opportunities, but you may have to move. I had to move twice from my hometown to get the jobs and the
experience that I wanted. But I came back here to the job that I always wanted to have.

What do you like about your job?

I like my job because, within the hospital setting, I'm involved in a multi-disciplinary team and my role is quite

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 important, as are the roles of the other people in the team. I feel that I'm in an important role. And I find that to be
something that I enjoy.

I like the fact that I communicate with the public and the privilege of really knowing a bit about their background and
a bit about their lifestyle. And visiting people in their own home is a privileged position to be in.

I like the communication that's involved in my job, not only with the service user, but with the different professionals.
I also enjoy the role of assisting people with what they want.

What do you dislike about your job?

Changing my workload priorities frustrates me at times, because I can't get on with what I want because something
more urgent has come up.

Sometimes there is a lot of writing: handwritten - that's just due to confidentiality - which at times can be strenuous.

At times it can be a challenge, working with the public. Although most people are quite grateful for the help that you
give them, a lot of times it is difficult to try and meet their wants, as opposed to what their needs are.

What are your ambitions?

In the short-term it would be to increase my knowledge here in the health setting: of different illnesses and different
diagnoses and prognoses. Just to satisfy my own curiosity.

As far as long-term ambitions are concerned - I haven't really thought that far ahead. I think that legislation and
changes in government requirements will probably dictate a lot of what happens in this field long-term.

I'm quite happy to be a social worker at the moment, and build up my knowledge in the role that I'm working in.

What advice would you give to someone interested in your career?

If you were to get a social work qualification, that would give you a basic knowledge of what it is to be a social worker.
But the best knowledge is experience.

I remember, when I was interviewed for my social work course, I was asked how much voluntary work experience I
had. I felt that that was a very valid question to ask.

Voluntary work is so useful because you get to meet people of different cultures and with different needs - people
who are disabled or people who have got mental health needs, for example.

If you can gain knowledge of people and their needs, it will give you a good idea of what sort of work you'll be
involved with. Doing the actual course is good in terms of the academic qualification, but it doesn't fully give you the
experience of working with people.

Again I'd say that a good social support network is important. Or finding ways of dealing with stress. A lot of jobs
nowadays do have a lot of stress and social work is variable, depending on what you are involved with. But
sometimes it's good to do things that will take your mind completely off work.

A day in the life

8.30 - 9.15amArrive at the office and set up for the day:

turn computer on
check emails
check phone messages
check agenda for the day
confirm an afternoon visit with health colleagues.

9.15 - 10.30am

Attend case conference on hospital ward. Present are consultant physician, hospital registrar, occupational therapist,
physiotherapist, ward doctors, staff nurse or ward sister, social worker and student nurse.

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 The consultant takes the lead in discussing each patient on the ward. Each of the professionals discusses their input if
relevant.

As a social worker I will only assess a patient who is medically fit. If relevant I state at what stage my assessment is
and what long or short-term plans have been made for when the patient is discharged.

My assessment is dependent on what issues the other professionals have highlighted in their assessments, ie
mobility, co-ordination, ability to wash and dress, personal care, diet, medication, etc.

10.30am - 12.00pm

Admin work - update file on each patient, including input from case conference.

Start new assessment if appropriate, by looking at existing files/records and discussion with the patient, their
family/partner, other people who may be involved in their lives, ie GP, district nurse, warden, community psychiatric
nurse, etc.

Phone agencies for relevant care packages or discuss existing care packages to see how they are working.

12.00 - 1.00pm

Lunch

1.00 - 3.00pm

Go to peripheral hospital. This is a community hospital where patients who do not need to occupy an acute medical
bed may be transferred.

Once there I meet with patients and relatives, check progress with staff nurses and with medical/nursing records.
Discuss the financial implications of going into residential/nursing care and what documentation is needed for
assessment to proceed.

3.00 - 4.00pm

A home visit has been arranged with an occupational therapist and physiotherapist.

We're visiting a patient's home (along with the patient) to see what potential risks exist for the patient if they are
discharged from hospital. This could include wiring, carpets/rugs, kitchen layout, and suitability for extra equipment
like a hoist, commode, trolley, mobilator, etc.

We also check the suitability of the staircase, and, if the staircase is inaccessible for the patient, we'll check if the
downstairs is suitable to live in.

4.00 - 5.00pm

Return from home visit. Update assessment and pass on to be typed up. Update the case records on file. Quickly
check messages and make arrangements for other visits later on in the week.

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