Healthcare Social Workers

Job purpose

To assess, counsel and advocate for patients and their families, and to plan and coordinate the referrals, care and discharge arrangements surrounding medical treatment, so that people living with chronic, acute or terminal illness reach the services they need.

Skills

• Professional command of human behaviour and of the methods of counselling, treatment and rehabilitation for physical and mental dysfunction in a clinical setting, supported by knowledge of group and cultural dynamics and of the financial assistance, legal aid, housing and education provision patients are referred to. A master's degree is the norm, with smaller numbers holding a bachelor's degree or a post-master's certificate, and extensive related experience is assumed on appointment.
• Counsels patients individually and in groups to help them overcome dependencies, recover from illness and adjust to changed circumstances, and explains end-of-life symptoms and options so that they can decide for themselves. Organises support groups and counsels relatives so that they can support the patient. Advocates for patients in crisis, negotiating with clinicians, agencies and funders, and directs other workers delivering services to patients.
• Builds a plan of care and rehabilitation from consultation data and social work experience for circumstances rarely alike, identifies environmental impediments through interview and record review, and modifies treatment plans as the patient's status changes. A discharge to an unsuitable setting, or a need not recognised, bears directly on the patient. Judgement is professional rather than procedural, exercised within care plans, statutory duty and professional standards.
• Coordinates each patient's care and rehabilitation and checks that services obtained are working, records progress against the measurable goals in the care plan, and plans discharge home or to another facility — which requires several parties to be aligned by a date the clinical course sets. Sets own priorities across a concurrent caseload under continuous time pressure, and separately plans programmes on substance misuse and community health.
• Work is carried out seated at a desk on clinical record systems, at the bedside and in meeting rooms, with travel by vehicle to patients and facilities.

Responsibilities

• No general line management, but supervises and directs other workers providing services to patients, and coordinates clinicians, agencies and family carers around a single plan of care. Also advises on social policy and assists in community development.
• No budget holding. Refers patients to financial assistance and legal aid, and oversees Medicaid- and Medicare-related paperwork in hospitals, where accurate eligibility documentation determines whether care is funded.
• Ordinary care of a workstation, clinical record systems and a vehicle used for visits. No responsibility for stock or plant.
• Owns the social work record for each patient — assessment, case history, care plan goals, progress notes and discharge arrangements — confidential material relied on by other professionals deciding treatment and placement. Where child abuse or neglect is suspected, investigates and records the evidence on which authorised protective action rests.

Effort required

• Assimilates clinical, social and financial information from several sources into a single assessment, holding concentration across a caseload of patients whose circumstances change without notice. Decisions are made frequently, on incomplete information and against clinical timescales, under time pressure and a constant volume of telephone and e-mail contact.
• Requires sustained contact with people facing chronic, acute or terminal illness and their families, including conversations about dying, crisis advocacy and, where abuse or neglect is suspected, protective action. Conflict situations are a regular feature, patients and relatives may be angry or discourteous, and much of it is conducted at close physical proximity. Composure must be maintained while absorbing distress that is not personally directed.
• Predominantly seated work at a desk and at the bedside, with movement around wards and clinics and travel between sites. No lifting or exertion is recorded.

Working conditions

• Indoors in environmentally controlled hospital and clinic premises, with travel in an enclosed vehicle to homes and other sites. Sustained close proximity to patients carries recognised exposure to disease and infection. The dominant demands are psychosocial: conflict situations, dealings with unpleasant, angry or discourteous people, and continuing exposure to serious illness and bereavement.
• Almost all incumbents work a regular established schedule, with no shift, rota or on-call expectation recorded; half work exactly forty hours and a slightly smaller share work longer. Substantial freedom to determine tasks and priorities is exercised within care plans, statutory duty and professional standards, with frequent decisions of real consequence for patients and colleagues, under time pressure.