Why social work is important but not a healthcare profession

A comment, from Byran Driver, has come in about a post a while ago on 19^th July; the comment is attached to the post, but I’ll reply in this new post:

I have recently been reading your blog and I was wondering if you could expand upon your point that you do not believe in palliative care and the hospice movement?

The link to the original post. 

What I said was:

I don’t totally believe in palliative care and the hospice movement.

This was as part of one of my musings around the time that I retired from working in a hospice (actually, St Christopher’s, the original hospice of the ‘modern’ hospice movement). Link to St Christopher's Hospice

There’s a personal aspect of my not totally believing in palliative and hospice care. I am by trade a social worker; my first loyalty is to social work and I have a particular interest in its role in society. But I don’t have an overwhelming commitment to its role in all sorts of other services in which social work plays a part. Unlike, for example, my boss there, Professor Dame Barbara Monroe, who is a very skilled social worker, but who once told me that she saw herself now mainly as a palliative care and healthcare person. The prof and dame are for her achievements in palliative and bereavement care, not specially in social work.

So there are points to be made here about professions and about social work.

Unthinking healthcare professionals sometimes talk about social work as a healthcare profession, forgetting that social workers also work in criminal justice, education, housing, social security, community work and all sorts of other fields. When you point out to them this limited perspective on social work generated by their primary professional location, they’re a bit flummoxed, because many can’t quite conceive of something that does not give priority to healthcare.

I once talked about what a professional is to an audience of healthcare professionals, and several of them defined ‘professional’ as someone who had a caring role. When I asked them about architects or accountants, they were unable to conceive of them as professionals. I asked if they would trust me, a social worker, to design bridges that they drove their cars over, or to check that the companies they were investing their pension funds in were using their funding appropriately.  No: and they had to concede that the training of both professions was about as long as medicine, and was highly technical and difficult to pass.

One problem was that architects and accountants did not have ethical responsibilities. I asked whether an architect who agreed to cheap building techniques in an earthquake zone that led to buildings collapsing and killing their occupants had ethical responsibilities. Or since we were going through the financial crisis at the time, what about accountants who had accepted manipulation of accounts to show that various investments were reliable when they weren’t? No: so they had to accept that non-caring professions also had ethical responsibilities.

The real issue for them was that such professions do not have responsibility for the care and well-being of human beings. So, their work did not matter so much as medicine or nursing. Their view was that social workers were professionals to the extent that they were involved in such responsibilities. But what about buildings that collapsed killing their occupants or pension funds that collapsed leaving their pensioners destitute? By these sorts of arguments, I drove them towards accepting that all sorts of difficult tasks done by a variety of professions required high-level education and involved ethical and practical responsibility for human beings.

So what about social work? I argue that the main objective of social work is to improve the capacity of social structures, social relationships and social institutions to respond to people’s difficulties: individual and collective difficulties. Social work is in lots of places in society because by increasing the resilience and capacity of families, communities and individuals to work with, support and help each other we improve the capacity of all sorts of other provision to function well in our society. Societies recognise that doing education, housing or even healthcare is not enough: people need to be helped to make the best use of it, and the social relationships and institutions around them need to be developed so that people can benefit from healthcare and other services. No good having excellent doctoring if people’s schools or employment or the social security system provide unhealthy environments or don’t support them in the things they need to do to tackle their illness or disability.

Social workers, therefore, are involved in all sorts of institutions, including healthcare, as an instrument in achieving their main goal: making society more resilient in dealing with difficulties. We do it in healthcare, because that is a location where people come up against difficulties that are hard to manage. Social workers can therefore use involvement in healthcare to get at families, communities and other social structures that are not giving people opportunities to live a good life and try and improve it, so that they can better cope with their family or community difficulties the next time.

That’s why, to me, social work is the priority, not a particular healthcare provision: it’s what I’ve always been interested in, and I think it’s an important priority for some people to focus on that in any society. That’s why most societies have a social work profession. It's one of the useful and difficult jobs that go alongside all the other professions.

But this does not answer the main point of Byran’s comment, which was less about my personal priorities and more about palliative and hospice care. More on that tomorrow.