World Social Work Day (Tuesday 15 March in 2016) is a good time to look back to the history of social work – and, for us, its historic relationship with the NHS. It suffers from not being a profession with a history as long as medicine or having the totemic figures of nursing. Like occupational health, it can be a largely invisible profession to everyone but those for whom it shapes their experience with the NHS. This means social work is not necessarily an obvious aspect of the NHS’s history for us to think about, but it is an important one. So what is that history?
Of course, there are many kinds of social work, each with its own history. And since illness, disability and, more positively, health, impact so greatly on all our lives, the NHS may be a greater or lesser feature in most social work. But here I’d like to say a little about, and hopefully prompt a few memories of, hospital social work.
Social workers first arrived hospitals to weed out those abusing the hospital by seeking free admission when they could afford to see a doctor, by definition not requiring hospital treatment in an age when medicine was far less dependent on the technology of the hospital, and ask for an appropriate financial contribution from the rest. We might say they operated the hospital means test. But there was no need for this after 1948, as I’ve written about for an entry in our encyclopaedia on Social Work and the Coming of the NHS. What’s more, when charges for prescriptions and other items were introduced just a few years into the NHS, social workers refused to have any role in collecting them. Money continued to be important, but in a different way. As I was told by one person, who had been a social worker’s assistant in the 1960s, a huge amount of the work was geared towards assessing a patient’s financial circumstances. But the purpose of this was not to determine the amount to ask them for, but to ascertain what benefits they should be claiming.
When she came to write her Consumer’s Guide to the British Social Services in 1967, one-time hospital social worker Phyllis Willmott explained that it was that the job was:
to help patients with their worries and difficulties – either practical problems over work, money, housing, or more personal emotional or domestic difficulties, or a mixture of both. She has (if she is experienced) a wide knowledge of all kinds of social services available; she is also trained to understand and help with the very real and acute personal or emotional difficulties which can lie behind some illness, or be caused by them.
This period of social work’s history could easily be lost amidst myriad organisational changes – not least reorganisations of the NHS and local government, just as medical social workers were being moved from one to the other – and being part of wider structures was important. Indeed, there were no new hospital built until the 1960s, but there was a real increase in the number of social workers trained and appointed to work in them before that. The Warwick University Modern Records Centre website hosts recordings of Social Workers Speak Out – interviews with 26 pioneers of social work, 5 of them hospital social workers, who reflect on what was for many a golden age of hospital social work.
Those interviews took the story up until the end of the 1950s, and the next period was one in which the character of social work was changing to become more sociologically and psychologically aware. This took place against of backdrop of the politics of anti-discrimination, a new era to adapt to but also one that some recall fitting well with a long-standing ideal of seeing and respecting the whole person. But how to think of that person: a patient? a case? a client? a consumer? a service-user? etc. etc. And broader political changes meant social workers, as in the early days of the profession, had to once again become experts in helping them navigate a complex mixed economy of welfare. Indeed, the latest chapters of hospital work’s history see social workers themselves increasingly employed by neither the NHS nor local government.
In truth, we know very little about social work in the history of the NHS. That’s why a project like this is so important. So please do share your memories with us. Do you remember a social worker from your time in hospital or did they help you access the support you needed from the NHS? Perhaps you were a social worker or assistant who worked in an NHS hospital. If so, how were you seen and treated by the patients and the other hospital staff? Did the NHS make a difference (good or bad) to the way you worked with your cases when they were dealing with health problems? You can use the comment section below to tell us, or you can sign up as a member to join the general discussion in our MyNHS members area.