Abstract

This thesis concerns the practice of social work in acute NHS hospitals in the UK. Admission to hospital is a significant event for some patients and may trigger referrals to adult social care. However, only a handful of existing studies have looked at social work practice in acute NHS hospitals. This research uses mixed methods to build a critical realist picture of the way in which the structures of the NHS and local authority social care services interact with the autonomous practice of individual hospital social care practitioners (social workers and wellbeing officers). Data were gathered using Freedom of Information requests to local authorities and NHS Trusts, semi-structured interviews with hospital social care practitioners across two teams, and an online survey completed by social work practitioners across the UK. Analysis and synthesis of this data supports findings from previous research. Assessment and discharge planning are the core functions of hospital social care practitioners, but advocacy on behalf of patients and families, and legal literacy, are also vital functions performed by these professionals. New knowledge is also presented; there is evidence that social work is being moved out of acute hospitals. Furthermore, around 40% of staff in hospital social work teams do not hold a recognised social work qualification and there is a lack of clear delineation between the responsibilities of a qualified social worker and others performing similar roles. In addition, it is demonstrated that tensions between hospital social care practitioners and the systems they work within might be framed in terms of care ethics. Neoliberal systems prioritise individual responsibility, autonomy, and efficiency of welfare provision, and this can frustrate the way hospital social workers prefer to practice, that is, in a way that prioritises communication, relationships, and providing what patients need to have a good future. Practitioners value the way in which they develop a contextual understanding of patients, yet their efforts to meet need are often frustrated by a lack of resources. The thesis concludes by developing a model of care ethical social work practice, that can be used by hospital social workers and other social care practitioners, to explain their contribution to the care provided in NHS hospitals.