Critical Social Work as Human Rights practice in Hospital Discharge settings

Introduction

This essay will discuss Critical Social Work as Human Rights practice in Hospital
Discharge settings. It is undeniable that in hospital settings, besides human rights,
social work is a profession that works with risk and poverty. I chose this topic
because the process of discharging people from hospitals during the Covid-19
pandemic had raised human rights issues, including their right to liberty, well-being,
and independence.
Prior to the pandemic, all the necessary assessments to facilitate a safe discharge
were taking place in the hospital setting. According to the new Discharge to Assess
model (D2A), these evaluations should no longer occur in the hospital but rather at
the person's home or in a care facility. Instead, in order to accommodate additional
patients, the focus is on freeing up hospital beds. This is a source of worry, given the
aim of the evaluations that were conducted in the hospital was in part to verify that
the discharge plans were safe once they were completed. When addressing hospital
discharges during the present pandemic, my aim is to examine how critical social
work can be applied.

Critical Social Work is social workers' ability to perceive a person's

situation as a result of other broader social processes and events that may
have affected them directly or indirectly. Those who practise Critical Social
Work strives to achieve a complex interweaving of goals applicable at both an
individual and a social level. A further feature of Critical Social Work
practice is an enhanced awareness of power disparities between social workers
and their clients, which is the second characteristic. (Weiss-Gal et al.,
2014). A third trait is the ability to collaborate and converse with others.
Individuals receiving services, members of their families and communities and
other professionals are all regarded as essential partners who possess
knowledge that is relevant to the interpretation of complex and uncertain
situations, difficulties, and needs, as well as the decision-making and
intervention processes in which they are involved (Spencer et al., 2000). The
knowledge and attention paid by social workers to the importance of language is
the fourth aspect of Critical Social Work Practice (Rossiter, 1996). To do
critical social work effectively, social workers must refrain from employing
language that generates resistance between them and their clients or fosters
uneven power relations between them and their social workers. (Weiss-Gal et al.,
2014). Conventional social work is a method that prioritises doing assessments and
meeting the needs of clients by setting up necessary services and supports.
Conventional social work focuses on professional competencies, standards,
accreditation, professional growth, and ethics (Duffy, 2017 citing Mendes, 2009) On
the other hand, the purpose of critical social work is to empower individuals with less
power by challenging systems rather than the individual (Duffy,2017 citing
Chenoweth and McAuliffe, 2015; Payne, 2014)

Various literature has pointed out that social workers are essential contributors to the
collective construction of human rights and recognise that human rights are
contentious and complex in social work. The key issues identified in Hospital settings
demonstrate that in some situations, it appears impossible to reconcile the approach
of beginning with the needs experienced by communities with the bureaucratic
processes of institutions inside a system, despite relying on human rights. (Reynaert
et al., 2022). I will discuss key issues in the following chapters from a critical social
work perspective.

Human rights have been a part of social work for more than a century, first in
writings, then in accounts of and about human rights activists, and finally in many of
the standard documents of the International Association of Schools of Social Work
(IASSW), the International Federation of Social Workers (IFSW), and the
International Council of Social Welfare, which have become "institutionalised"
(ICSW). The International Commission on Human Rights was founded in 1988.
(Staub-Bernasconi, 2016). The Human Rights Act 1998 became effective in the UK
on October 2, 2000. This Act had ramifications for the National Health Service, but
they are hypothetical and have not yet been extensively tested in court.

Ageism

The UK's National Health Service, established at the end of the Second World War,
represent a citizenship right to the best health care. Since the NHS was founded, the
needs of the population and the field of medicine have advanced to the point that
they have undergone a complete transformation, such as fewer children and living
longer lives, even though expectations regarding the universality of NHS provision
have not changed. (Burrows, 2020). Future of an Ageing Population, a recent report
from the Government Office for Science, serves as a helpful reminder of the extent
of the changes we must adapt to. It outlines the aspects of our society that the
ageing population is affecting, including the workplace, how and when we learn, the
neighbourhoods where we live, the family and household structure, the availability of
health and social care services, and how we use technology. (The future of an
ageing population needs a response today, 2022)

Due to the current environment, case management practises in social work have
changed, resulting in practitioners' de-professionalisation (Gorman, 2003). Social
workers have taken over the administrator position, and the evaluations carried out
are based on recommendations to other professional organisations. Their
administrative responsibilities hampered the social workers' ability to deal with clients
more personal. We can observe a similar process in developing the role of nurses
and doctors. Nursing has changed from a 'vocation' to an occupation throughout the
years. (Jolley, M.,1989). This has added more administrative responsibilities;
therefore, nurses have less time and resources to spend with the patients. This can
be problematic when majority of inpatients are considered old age. Studies have
shown that social interaction are more important for elderly people as part of their
care. "The effect of both the ongoing development of medicine and the
professionalisation of nursing is that wards and clinics have become spaces in which
the emphasis is upon cure rather than care" (Burrows, 2020 page number ). The
author follows up by explaining that at present times institutions like hospitals are
potential grounds for ageist practises, and this is not always due to deliberate
neglect to patients' feelings, rights, or well-being as they age; rather, it's because
hospital's organisational cultures evolved from a model in which specialists in narrow
disciplines were cultivated.
 “Older persons face challenges that are not addressed in existing international
human rights standards’’ (Ageism in human rights law, 2022). According to a survey
by the London School of Economics, one million older people in hospitals
experienced 'low or unequal standards of dignity and respect,' and 640,000 reported
not receiving sufficient assistance with eating. (Human rights of older persons and
their comprehensive care July 2017, 2022) From a critical social work perspective,
there is no single department accountable for addressing all of the concerns. The
ramifications span numerous departments such as economy, infrastructure, human
resources etc., with the implementation of policies by one frequently having a direct
or indirect impact on another. These connections imply that the goals of one
department may be achieved through the policies of another (The future of an ageing
population needs a response today, 2022). Traditionally, conventional social work
would act oblivious to this; a critical perspective is necessary, especially in hospital
settings where delayed discharges have created a “blame culture’’ on social
services. A significant number of delays are caused by external organisations or
caused by NHS alone; critical social work would challenge the preconceptions that
social services are entirely responsible for delayed or premature discharges.
(Burrows, 2020); Practitioners would identify and work with the underlying social
factors responsible for the current social order.

Although effective discharge planning requires time, speed is prioritized over all
other factors in the hospital's system. A holistic approach in which complexity and
uncertainties are adequately addressed is crucial for effectively discharging older
adults whose health is frail. Prioritizing efficiency and minimizing risk makes patient
compassion a secondary consideration and promotes patients' social and
psychological requirements to be neglected. In the hospital environment, older adults
are seen as ‘’difficult to treat’’, blocking beds and not responding to interventions
similarly to a younger person. The ageing population is expected to be an indicator
of good health; unfortunately, in a market-focused ideology, being older is not
valuable for the economy; this has implications on family dynamics when it is
expected for younger people to work and take care of their elderly. Critical social
work will challenger for older people outside of the hospital setting such as housing,
loneliness, and abuse. Burrows suggests that critical gerontology

Neoliberalism

Neoliberalism has changed the way social work is performed since the
1970s(REF?). Harris (2014) says that ‘’neoliberalism's effects on social work can be
summed up in three main ways: marketization, consumerization, and
managerialism.’’ (Older People: Covid19 meets neoliberalism (NM), 2022)
Permanent jobs and relationships, shared responsibilities have been replaced by
globalisation and intolerance of imperfections. Older people in a neoliberal ideology
face challenges when the ‘’risk is transferred from the State to the individual’’ (Ageing
in an era of neoliberalism: the impact of extending working lives | British Politics and
Policy at LSE, 2022)
When addressing the mental health of older people, neoliberal ideology promotes
the medicalization of distress, by focusing on personal responsibility and diverting
attention from the complex interactions between ''human bodies, medicine, and the
social, economic, and political aspects of health and illness'’. An emphasis on human
rights will address the underlying societal issues that are contributing to illnesses.
(Herrawi, F. et al., 2022)