Critical Hospital Social Work Practice by Daniel Burrows

Author:Daniel Burrows [Burrows, Daniel]
Language: eng
Format: epub
ISBN: 9780367203849
Google: 3w7zzAEACAAJ
Barnesnoble:
Goodreads: 50162784
Publisher: Routledge
Published: 2020-01-15T01:42:29+00:00

Discretion

This chapter has so far outlined a bureaucratic system that aims to ensure that the HSWs keep efficient and swift discharge of patients as their highest priority. Despite the control of HSWs’ practices through managerial techniques and the limitations on the ways in which they can engage with patients and carers, however, the system also relies on HSWs using a certain level of discretion in their daily work. Evans and Harris (2004) argue that Lipsky’s (1980) concept of street-level bureaucracy remains relevant in social work, since some discretion is always retained by practitioners whatever rules, regulations or procedures are in place. Lipsky (1980) argues that social policies are formulated not only by governments through legislation, or by senior managers in charge of developing organisational goals and procedures, but also by government workers who have direct contact with the public, as they must interpret those policies and implement them as ‘street-level bureaucrats’. Thus, government or management policies are often reinterpreted and distorted by street-level bureaucrats, who exercise high levels of discretion and autonomy, and whose practices evolve to help them to manage their work in their own interests, whether to cope with a high demand for services, to reduce uncertainty and dilemma, or to give preferential treatment to certain types of citizen (e.g. on grounds of acceptable behaviour or some form of prejudice).

The concept of street-level bureaucracy remains relevant to HSWs because their interactions with patients remain unobserved by managers, and because the eligibility criteria for patients to receive services from the local authority do not eliminate discretion. Eligibility criteria and strict definitions of what needs can and cannot be met by social workers reduce the range of choices available to social workers (Ellis et al., 1999), yet HSWs retain power over how information is presented to the managers who must approve their care plans. Knowing the eligibility criteria well means that HSWs are able to present patients’ needs in a way that almost guarantees their receiving a service and it is rare for care plans to be rejected. Where managers do refuse approval for a care plan, this is commonly interpreted by the HSW as a sign that more information is needed, rather than that their interpretation of the patient’s needs is wrong. In such instances, the social workers will seek further information from their clinician colleagues, rather than give up on the care plan they have suggested.

The discretion of the HSWs extends beyond how they present information about their patients to secure them services. Despite the expectation that they should expedite discharges as quickly as possible for every patient, HSWs do take more time when they are able and feel it is warranted, for example when the patient presents complicated issues:

Like this case I’m working on now, the husband’s got Alzheimer’s and has EMI [services for the elderly mentally infirm] involved and now she’s not mobilising but she was a couple of months ago and something’s telling me there’s something underlying, but they’re saying she’s ready to go and it just sometimes happens.

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