When the green paper Every Child Matters first crossed Lesley Nicol's desk at Sheffield Children's Hospital, there were no real surprises. Nicol has been a member of a social-work team based in the hospital since 1986 - long before civil servants came up with phrases such as "multi-disciplinary" or "co-located services". Now she manages a three-strong team of social workers based in the oncology department.
"Nothing in that green paper was very new to us, especially when it talked about crossing boundaries and improving communication," she says. "Social workers have a huge amount of good points that have been lost, and we all deserve the respect that comes from being listened to as professionals."
Her team - half-funded by the Sargent Cancer Fund for Children and half by Sheffield City Council - sees every child who is diagnosed in the department, which amounts to about 80 new cases every year. "Social work here is based in a secondary setting," she continues, "you're not in an office and you have other professions on tap."
In fact, each family is seen by a multi-disciplinary team, which includes a social worker and a range of medical and nursing staff. As Nicol explains: "We have the freedom to work quickly and flexibly. For instance, if parents need a bereavement group, we can do that as we respond to the need at the time.
"It is good social work and, as social workers, we are here for a lot of things - not just to offer support and advice, but also to provide practical, emotional and financial help."
However, because Sheffield Children's Hospital is a regional facility, Nicol's staff can find themselves talking not only to social services in Sheffield, but also those 70 miles away in Grimsby.
She says that no matter where the families are from, they all need reliable and easy-to-understand information at what can be difficult times - something that is a key role for the social worker. "By communicating properly, you give families the power they need," she says. "Paediatricians are usually excellent and the medics I work with are good when it comes to thinking about what they are saying to families and patients."
Chris Finnigan is service manager for children with disabilities at Sheffield Social Services and co-ordinates the work of four teams based in three hospitals in the city, including the onco-logy social-work team and another that works across the different wards and departments at Sheffield Children's Hospital. She says that, historically, the role of the social worker has not always been one which medical staff have fully understood, or perhaps respected.
"When you are working as part of a health team it is the health practitioners who lead your work, but they are not always clear about what social work is. They sometimes don't know what they should be bringing to the social worker.
"And some of the workers have said to me that they feel they are bottom of the pole, and don't know if they come above or below the porter," she adds. "But the advantage of being in a hospital is that they are visible and the staff don't tend to forget that they are there."
According to Julian Roberts, paediatric surgeon and medical director at the hospital, the presence of social-work teams at the hospital "has made life a lot easier. From our point of view, it is a way of being able to sort out all sorts of surrounding problems."
Finnigan believes that once the social worker's role is established, the flow of information is much easier. "If the team was based in an office, it could be hard for, say, a paediatrician to get hold of them to highlight concerns about the welfare of a child."
Setting standards
However, what works in one hospital does not automatically translate into a blueprint for success because, as the green paper points out, "co-location requires considerable local flexibility". This is a message that's welcomed by Penny Thompson, co-chairwoman of the children and families committee at the Association of Directors of Social Services. She stresses that what might work well in one hospital would not necessarily work as well in another.
She says the green paper's recommendations on co-location were already happening. "Many places have had hospital-based social workers for many years," she says, "but we want the Government to make it clear what standards it wants to see because it's important that government sets the standards and frameworks for social workers."
For Thompson, though, the benefits of working together are huge. "While it's critically important when you're working in multi-agency teams that you preserve the individual skills and knowledge of the different professions, both medical and social-work staff would say it's important to come together because a social worker in a hospital will bring complementary skills. And, when you work together you get to know people and build up a trust."
She does warn that, even with established teams, there could still be different approaches. "In a maternity setting, for example, social workers feel that medical staff have the mother as their primary focus, whereas our staff's focus is actually on the child."
On the other hand, the word from the Department for Education and Skills (DfES) is that proposals on multi-agency working have been welcomed. What's more, although the green paper was drafted in response to the Victoria Climbie inquiry, the DfES had seen the idea of multi-agency working gathering momentum well before that.
Building relationships
For instance, Dame Lorna Boreland-Kelly heads two teams of social workers at Mayday University Hospital in Croydon. The hospital has had an in-house social work team since the early 1980s and its current set-up since 2000.
The team is part of Croydon's Assessment Service section and helps children under 18 and their families. Much of the work of the Mayday team comes out of the paediatric and maternity wards at the hospital as well as from the accident and emergency department. The team also gets referrals from members of staff or patients.
Work at Croydon revolves around teenage pregnancy and self-harm, but also supports children who need help because of their health, a disability or because their parents are ill. In addition, specialist support is available for children and their families affected by the HIV virus, and there's a student training unit where up to three trainee social workers will get involved in preparing pre-birth assessments and working with ill children.
Boreland-Kelly explains that the teams had worked hard to build a relationship with the rest of the medical and nursing staff at the hospital.
Finally, all new recruits at the hospital also receive induction training where they learn about the social-work team and its role in Mayday. "We take the view that any part of the hospital could come across children," concludes Boreland-Kelly, "so whether you are a porter or a nursing sister you need to know about us."
Further information Sheffield Children's Hospital www.sheffield.nhs.uk Social-work team in oncology: 0114 2717406. Mayday University Hospital www.may dayhospital.org.uk Social-work team office: 020 8401 3409.
FACT FILE
What the green paper says on co-location
- There is a strong case for basing multi-disciplinary teams in and around places where many children spend much of their time
- Co-location requires local flexibility as opportunities and barriers differ depending on local geography
- Services should focus on the needs of the children and, in turn, should be where they and their families can reach them
- Co-located services promote inter-professional relationships and trust
CASE STUDY - THE TOMLINSONS' STORY
Evelyn Tomlinson was born seven weeks premature to parents Anna and Darren. Six months later, their joy turned to despair when doctors at Sheffield Children's Hospital told them their little girl had leukaemia. "I was just completely in shock," admits Anna, "and, to be honest, I would never have thought about seeing a social worker."
The hospital social-work team saw the couple and Evelyn the day after the diagnosis and, for Anna, they have been invaluable ever since. "If you ask for things on your own, you might get a 'yes' or you might just get dismissed immediately. But with a social worker backing you up, it's very different."
For instance, the team helped to get Darren some time off work, and also helped the Tomlinsons to put in claims for disability benefit and invalid carers allowance.
Team member Liz East gave Anna contacts for a number of children's charities, one of which gave them a tumble dryer to help with the extra washing caused by the chemotherapy treatment making Evelyn very ill. Finally, the Sheffield couple are moving out of their upper-maisonette house and into a home that doesn't have five flights of stairs before the front door. "I don't think the council would have listened to us without the social worker being there," says Anna.
"The social workers have done so much for us, visiting us at home and while we are at the hospital. But, apart from the practical things, they are just there for moral support."
As for Evelyn, she still has to undergo chemotherapy and will soon have a stem-cell operation to hopefully give her a better chance of winning her fight for life.
