SWHN
Brief notes of the seminar held on 27th March 2006 1 – 5
pm at the Franklin Wilkin’s Building, King’s College
London
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Seminar: Health Service History
Chaired by Joan Baraclough
Attended by 45 SWHN members and guests
History on the Hoof – the problems and pleasures of writing
contemporary health and social history
Geoffrey Rivett (GR)
GR referred to two books that he wrote whilst working for the DH:
1. ‘The development of the London hospital system’ 1823 – 1982
2. ‘From cradle to grave: fifty years of the NHS’ (1998)
Both can be accessed via his website: www.rivett.net
GR explained that the challenge of tackling the complex development of NHS
history was partly addressed by determining key overarching structures to
provide the framework for more detailed text e.g. clinical developments ~ finance
~ politics. He resolved the constant problem of needing to update material by
use of web authoring. This has enabled him to rewrite sections of his books
when new facts have emerged.
The internet has the disadvantage that it provides bite-sized chunks of text. Long
books on the internet must therefore be accompanied by a detailed contents
page of each chapter, identifying the particular topics. The potential problem of
multiple referencing may in some cases be overcome by directing readers to
abstracts on identified websites. Where organisations such as the DH change
their websites, the problem remains but may be reduced by identifying the
document in full.
Web authoring requires observance of rules about web design and accessibility.
By using a tracker facility it is possible to see who uses the site, how they use it,
where they are from, and what they have searched for. GR’s website tends to be
used by health services, economists, social services and people studying the
broad range of topics associated with healthcare.
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GR stated that all large institutions have similar problems, the NHS and social
services no less. There is also the problem of subjectivity and objectivity – how
far do we write our history rather than that of the people receiving services, and
where is the service user history to be found? Vested interest groups have their
own bias. GR suggested that anecdotal information provided a good source of
service user data. Researchers are also confronted by problems of changing
service configuration and definitions. For example, much of the NHS history is
about nursing rather than medicine. However, there have been many shifts in
the location of nursing provision from hospital to community care. In addition, the
nature of the workforce is changing with increased use of unqualified staff.
GR conceded that social services history was more complex and not as ‘crisp’ as
that of the NHS. The term ‘social services’ creates problems of definition and
boundaries. Its history lacks clear landmarks and it is therefore difficult to find
events worthy of note. Doctors are also largely self-employed unlike social
workers. Social workers may therefore be more restricted in what they can write.
Discussion points:
 Website updating – can destroy history – hard evidence can disappear – a
recognised problem
 Service user data are found in a scatter of systems and institutions –
Ombudsman – complaints
 Health and social services share an interest in ‘quality of life’ issues –
service user groups are documenting their experiences
 ‘Quality of life’ issues tend to be pushed to the background
 Healthcare ‘qualys’ are a crude way of gathering data and miss important
subtleties – audit tools need to be ethically driven
 Patient questionnaires are often poorly designed and limited in what they
can provide
 History is essential to determine whether the motives of the past are
relevant to the present – yet medical history is not taught and the same
often applies in social work education
 Development of nursing profession – sources are very limited, scattered
and much has been destroyed
A point about the disappearance of flowers on hospital wards generated lively
discussion. This illustrated the many significant changes in attitudes, beliefs and
the workforce that had taken place since the introduction of the NHS
The lady almoner – a search for roots
Angela Simmons
Angela Simmons led a discussion of her (unpublished) book A PROFESSION
AND ITS ROOTS -- THE LADY ALMONERS:
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‘The book asks questions - Why were Lady Almoners appointed at the end of the
19th century? What defined them? What values and ideas had they inherited? It
also asks how philanthropy was transformed into professional social work, and
how did the lady charity workers turn into Lady Almoners? The context of the first
appointments is examined - it was a time of vibrant social change - and the risks
and the difficulties, such as hostility from the medical profession, are discussed.
Toughness as well as tact was required.
The cultural and religious background, the role of the Charity Organisation
society, and the nature of the work undertaken is discussed. Extracts are given
from the thinking of Social Work pioneers and from the records of the first Lady
Almoners. The American input is discussed.
Finally developments since 1964, when the Institute of Almoners changed its
name, to the Institution of Medical Social Work. Ten years after that the
employers were the local authorities, and the specialism became known as
Health-Related Social Work. But, meanwhile, there has been an increase in the
number of voluntary organisations employing hospital-based social workers’.
(AGS March 2006)
Discussion points:
 The early pioneers (e.g. Ellen Raynard) were employed and paid by
charitable and missionary societies; the later almoners were in most cases
paid by the employing hospitals
 Almoners could access hospital and other charities seeking financial
assistance for patients
 The early almoners were expected to attend training and receive
supervision
 The Anne Cummins scholarship Fund (AC being one of the early
pioneers) accrues £1,500 p.a. and is managed by the Social Work
Education Trust.
Whatever does the social worker do? Reflections on 60 years of
social work in the NHS
Ann Davis
The University of Birmingham will be celebrating 100 years in Social Work
Education in 2008. Past students will be invited and it is hoped that SWHN will
also contribute. The Birmingham Settlement will also be involved as a founder of
the social work course at the University.
AD explained that Birmingham University did not teach social work history as a
module but aimed to embed it in the curriculum. She commented that given the
pace of change in services and service configuration, she was teaching students
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who did not know who would be employing then in the next few years or where
(agency-wise) they were likely to be located. A knowledge of history assisted
them thinking about what the future might hold for social work.
AD introduced a book written in 1946 ‘Whatever does the social worker do?’by
Dorothy Manchee, Almoner at St Mary’s Hospital, a text she shares with students
at Birmingham. It opens with the cosy gatherings of Miss Clavering (a fictional
character) with her group of almoners drinking coca and toasting bread, oblivious
of any health and safety issues, in front of an open fire. AD’s students are
astounded at the rigour and extent of the training that almoners then had to
undergo and the important place of supervision in the service. They remark on
Miss Clavering’s office, easily accessed by her staff, and the focus of work on
helping patients get the best advantage from their hospital visits. The almoners
were also like a ‘universal aunt’, involved in endless letter writing to charitable
funds, making Christmas presents for patients and decorating the outpatient
department on Boxing Day. The hospital was a community in itself and central to
the community it was in. And flowers were an important part of the almoner’s
work as they were ‘very humanising’. Miss Clavering commented that ‘hospitals
see bodies – social workers see people’.
Another source of fascination for students is Miss Clavering’s informal influence
on the hospital management, the dropping in of a hospital manager to seek her
advice before an important governors’ meeting. In terms of influence and
accountability, AD’s students are struggling in current services trying to find out
who does what and who makes the decisions in a constant sea of service
reconfiguration and change.
AD stated that student anecdotes illustrate similarities and sharp contrasts with
the position in 1946. As did the findings of a research study, she was involved in
funded by the Joseph Rowntree Foundation in the mid 1990s that looked at a
number of social work teams who were assessing needs for services.* Some
similarities are the importance of paper work and the need to write begging
letters. However, these now tend to be written by the students and social
workers themselves as experienced secretaries and ‘p.as’ have long gone. The
team manager’s office is a cupboard several corridors away and the students are
hot-desking for office space. The focus of the work is on hospital discharge and
care management duties. Older people and patients appear to be mystified
about the purpose of their encounters with social workers. A social work
presence in outpatients has disappeared and social workers comment on the
hostility of the hospital environment on social work. Web information relating to
local hospitals identifies social work support in relation to hospital discharge, but
nothing else. Careers for social workers in the community are advertised but
there is nothing about hospital social work. Generically trained social workers
learn about services for health and disability but not about illness and its effects
that was an important element of almoners’ training. In the early years of the
NHS (1940s – 1970), social workers in health were taught about the ‘elite’ of
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social work. Significantly, at the end of this era and on the brink of Seebohm
there were concerns about the likely effects of genericism and organisational
change on the future of health-related social work that appear to have come to
fruition.
Discussion points:
 The place of social work history in helping social workers reach and
recapture the integrity of the profession
 Social workers are once again having to learn how to write good begging
letters
 Are numbers of medical social workers diminishing and if so, who is filling
the gap? What counts as a medical social worker?
 An expectation that hospital admissions would be shorter and therefore
the need to emphasise step down facilities and discharge rather than
hospital social work
 Forensic social work and palliative care social work are the last bastions of
hospital social work
 Current research (see below) illustrates that carers and patients value
good social work when they experience it
 Social workers have to step outside the rules to do social work – they
recognise there is no one else to do the work
 Social work had many successes in primary care but then the profession
let it go – how can we ensure that our successes are not lost?
 Many referrals to social services are presented as social problems but
also contain unrecognised health problems
 Few social work courses teach the nature of illness
 There needs to be training about social work by social workers in medicine
and nursing
 The problem of finding a common language to assist health and social
services collaboration.
*Davis, A. et al (1995) Access to Assessment: perspectives of practitioners, disabled people and
carers Joseph Rowntree Foundation
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Business section
Chaired by Keith Bilton
2.1
Structural matters
KB advised that SWHN would be opening a bank account with Nationwide – for
the purposes of the account:
Chairperson: Joan Baraclough
Treasurer: Keith Bilton
Secretary: Joan Rapaport
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Core group members are: Joan Baraclough ~ Keith Bilton ~ Ruth Cartwright
(BASW) ~ David George ~ David Jones ~ Joan Rapaport (KCL)
NEXT CORE GROUP MEETING: TUES 16/5/06 JR’s office
2.2
Web discussion facility
See note from David Jones (DJ) seeking a volunteer to moderate an ediscussion facility.
Members were in broad agreement that a web discussion facility should be
pursued.
There was some discussion about the need for attention to security, personal IT
skills and accountability.
If anyone (with good IT skills) is interested in offering their services would they
please contact Joan Rapaport – joan.rapaport@kcl.ac.uk
Attention ALL
2.3
BJSW Special History Edition
Please send abstracts to Caroline
C.skehill@qub.ac.uk
2.4
Skehill
by
the
end
of
April.
Scholarship
Philip Osborn has founded a the Hazel Muras Osborn Scholarship, in memory of
his wife Hazel, at University of Southampton. The first award was made last July.
2.5
SWRiR
Following the last seminar at the British Library a May meeting is proposed
between BL and the Social Care Workforce Research Unit at KCL to see whether
the project to record the experiences of social care pioneers, funded by the Getty
foundation, can be expanded. If extra money can be found the intention is to
involve retired social workers who have attended the interviewing course at KCL
to carry out some of the interviews.
2.6
WISE
Please see note attached about project to capture social work experiences.
2.7
Date of Next Seminar
Mid-June – speaker Don Brand and two others.
Topic to be confirmed.
Notes: Joan Rapaport
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