A close and practical association with the medical profession: Scottish medical social workers and social medicine, 1940-1975

Medical History

Volumn 51, Issue 3, 2007, Pages 309-336

  Nottingham, Chris ^a   Dougall, Rona ^b  

^a GLASGOW CALEDONIAN UNIVERSITY   (United Kingdom)

^b NHS GREATER GLASGOW AND CLYDE   (United Kingdom)

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EID: 34547379326     PISSN: 00257273     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0025727300001460     Document Type: Review

References (152)

1. The research involved eighteen extended interviews with past and present medical social workers. Tapes and transcripts of the interviews are located in Research Collections in the Library of Glasgow Caledonian University. Tapes and transcripts of the witness seminar are in the same location, as are a collection of reminiscences of their working lives by a number of Scottish medical social workers. We are greatly indebted to Winnie Childs for the last, as it was she who persuaded many of her colleagues to record their memories and share them with us.
2. Jacqueline Jenkinson, Michael Moss and Iain Russell, The Royal: the history of the Glasgow Royal Infirmary, 1794-1994, Glasgow, the Bicentenary Committee on behalf of the Glasgow Royal Infirmary NHS Trust, 1994, p. 118.
3. Ibid., p. 119. See also Dorcas Society Records, Greater Glasgow NHS Board Archive, HB/14/12/5.
4. Almoners in the Mary Stewart mould were referred to as "lady almoners" to distinguish them from an older type of almoner, invariably male and exclusively concerned with money matters. We are indebted to Joan Baraclough for this information. "Lady almoner" was a term which many almoners disliked intensely.
5. M W Edminson, The middle period, or episode two, 1914 to 1939', The Almoner, 1953, 6(8):360-72, p. 363.
6. Ibid., p. 366.
7. The first years of the twentieth century produced one significant breakthrough when the work of the St Thomas' almoners with maternity cases was recognized by the Local Government Board report on infant mortality. E Moberly Bell, The story of hospital almoners: the birth of a profession, London, Faber and Faber, 1961, p. 102.
8. Edminson, op. cit., note 5 above, p. 370.
9. Records of the Glasgow Royal Infirmary (hereafter GRI), Almoners' Department, Greater Glasgow Health Board Archive, HB14.12/1-14.
10. Edminson, op. cit., note 5 above, p. 365.
11. M J Roxburgh, 'Episode three, 1939-1953', The Almoner, 1953, 6 (8): 373-81, p. 376.
12. Joan Baraclough, Grace Dedman, Hazel Osborn, Phyllis Willmott, One hundred years of health-related social work, 1895-1995: then . . . now . . . onwards, Birmingham, British Association of Social Workers, 1996, p. 22.
13. Report of the Inter-departmental Committee on Medical Schools, London, HMSO, 1944 (Goodenough Report). For the Institute of Almoners' own discussions of the evidence they wished to present to this committee, see British Association of Social Workers Collection: papers of the predecessor organizations 1890-1970 [MSS.378] Modern Records Centre, University of Warwick, MSS.378 A15/2:31.
14. Ibid., Minutes of meeting 26 March 1942, MSS.378 A15/2:31.
15. Rosemary I Weir, A leap in the dark: the origins and development of the Department of Nursing Studies, The University of Edinburgh, Penzance, published for the Department of Nursing Studies, University of Edinburgh, by the Pattern Press and the Jamieson Library, 1996, pp. 4-8.
16. Elizabeth Stirling, 'Almoners and the relation to social medicine'. The Almoner, 1948,1 (4): 75-6.
17. Aneurin Bevan in a speech to the AGM of the Institute of Almoners, March 1948, quoted in Baraclough et al., op. cit., note 11 above, p. 23.
18. Roxburgh, op. cit., note 10 above, p. 378.
19. Hospital Almoners, 1946 H.M.C. (48) 53; B.G. 48 (57) Sept. 1948.
20. Ibid. The membership of the internal committee included Eileen Younghusband of the London School of Economics, the Hon. Eleanor Plummer, Principal of the St Anne's Society, Oxford, and Or J G Scadding, Dean of the Medical School of the Brompton Hospital. They also recommended an additional year of training in a university and, a long-standing aspiration, adequate financial support for students.
21. Reports of the Committees on Medical Auxiliaries, Cmd. 8188, London, HMSO, 1951.
22. Ibid., p. 4.
23. Ibid., p. 26.
24. Ibid., pp. 27-9.
25. Ibid., p. 11.
26. Ibid., p. 125.
27. Ibid., pp. 125-6.
28. Hansard, House of Commons, Tuesday, 23 Feb. 1954.
29. Testimony from interview GCU/CCH T013 Almoners, Glasgow Caledonian University Archives (hereafter GCU Archives).
30. Ibid.
31. For an illustration of the importance that was placed on this question, see The Institute of Almoners, 'Report of the Survey Committee', The Almoner, 1953, 6 (2): 61-9.
32. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
33. Testimony from interview GCU/CCH T013 Almoners, GCU Archives.
34. Ibid.
35. Ibid.
36. Testimony from interview GCU/CCH T016 Almoners, GCU Archives. Scott was a fervent and articulate supporter of the involvement of almoners in medical training: "It is no longer any guarantee, because a doctor has lived and worked over a number of years in a particular district of a town, because he is essentially a humanist and a lover of mankind, because he is a trained and experienced observer, that he is therefore possessed of all the necessary knowledge of the physical and social circumstances of his patients." Richard Scott, 'The almoner and the family doctor', The Almoner, 1949, 1 (10): 209-14, p. 211.
37. For Scott, the almoner was an essential element in both the training and the day-to-day practice of the GP: "the almoner is the solution to many of the problems of general practice." Leslie Briggs, 'Research almoners' group', The Almoner, 1950, 3 (4): 135-7, p. 136.
38. Not everyone in social medicine was enthusiastic about involving almoners in medical education. Thomas McKeown, professor of social medicine at the University of Birmingham, felt that they could never match the high standards of teaching to which medical students were accustomed. Thomas McKeown, The contribution of the almoner in the teaching centre', The Almoner, 1948, 1 (2): 24-5.
39. For a full account of this unit and Paterson's explanation of the specific contribution the almoner could make, see Jane Paterson, 'The almoner's contribution to medical teaching', The Almoner, 1950, 3 (5): 163-77. For Paterson, "the medical student has usually no difficulty whatsoever in obtaining information from the patient on social matters. His real difficulty lies in the interpretation of the facts" (pp. 164-5). What the almoners could contribute was a knowledge of "systems" which would enable the doctors to make sense of the facts.
40. Testimony from interview GCU/CCH T013 Almoners, GCU Archives.
41. Testimony from interview GCU/CCH T017 Almoners, GCU Archives.
42. Testimony from interview GCU/CCH T014 Almoners, GCU Archives, McQueen's wife was not, as the interviewee believed, a health visitor although she was closely involved with both the profession and her husband's aspirations. We are indebted to Lesley Diack, who has written extensively on health visiting in Aberdeen, for this information. For a discussion of the relationship in Scotland, see M Jeffreys, 'The social worker and the health visitor', Health Bulletin, 1973, 31 (2): 72-5.
43. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
44. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
45. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
46. Institute of Almoners/Institute of Medical Social Workers papers from the British Association of Social Workers collection of the papers of the predecessor organizations 1890-1970, Modern Records Centre, University of Warwick, MSS.378 A15/16:4-9a, the committee operated from 17 Dec. 1951 to 8 May 1952.
47. Ibid., 28 Feb. 1952, MSS.378 A15/16:8.
48. Ibid., 28 Feb. 1952, MSS.378 A15/16:8.
49. LC Marx, 'Early days', The Almoner, 1953, 6(8): 346-59, p. 356.
50. Testimony from interview GCU/CCH T009 Almoners, GCU Archives.
51. Testimony from interview GCU/CCH T013 Almoners, GCU Archives.
52. Testimony from interview GCU/CCH T011 Almoners, GCU Archives.
53. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
54. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
55. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
56. Testimony from interview GCU/CCH T016 Almoners, GCU Archives.
57. Testimony from interview GCU/CCH T006 Almoners, GCU Archives.
58. GRI, Almoners' Department, Report to Board of Managers, 1948, Greater Glasgow Health Board Archive, HB 14.12/1-14.
59. GRI, Almoners' Department, Report to Board of Managers, 1952, Greater Glasgow Health Board Archive, HB 14.12/1-14.
60. GRI, Almoners' Department, Report to Board of Managers, 1957, Greater Glasgow Health Board Archive, HB 14.12/1-14.
61. Testimony from interview GCU/CCH T011 Almoners, GCU Archives.
62. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
63. Testimony from interview GCU/CCH T009 Almoners, GCU Archives.
64. Testimony from interview GCU/CCH T016 Almoners, GCU Archives.
65. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
66. Testimony from interview GCU/CCH T009 Almoners, GCU Archives.
67. Ibid.
68. From the interviews it emerged that many almoners disagreed with keeping patients and families ignorant of terminal diagnoses and that they were one of the influences that produced change.
69. GD2/5/4 Lothian HB archive, Edinburgh University Library.
70. See, for instance, 'Notes and News', The Almoner, 1953-4, 6 (1): p. 37, for an example of the continuous interest in the issue. "Last year a special enquiry disclosed that only 300 out of 1,300 hospitals which admit children, were up to that time allowing daily visiting by parents."
71. Testimony from interview GCU/CCH T009 Almoners, GCU Archives.
72. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
73. Ibid.
74. Testimony from interview GCU/CCH T013 Almoners, GCU Archives.
75. Institute of Almoners/Institute of Medical Social Workers papers from the British Association of Social Workers collection of the papers of the predecessor organizations 1890-1970, Modern Records Centre, University of Warwick, MSS.378 A15/16:20
76. GRI, Department of Social Work, report to Board of Managers, 1972, Greater Glasgow Health Board Archive, HB 14.12/1-14.
77. Testimony from interview GCU/CCH T016 Almoners, GCU Archives.
78. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
79. Testimony from interview GCU/CCH T008 Almoners, GCU Archives.
80. Distinguishing the almoner from other personnel was always an issue. From the 1910s at St Thomas's "hats, large at the time, were worn when going about the hospitals, or mixing with the patients, as a distinguishing mark." Marx, op. cit., note 46 above, p. 356.
81. Harriett M Bartlett, Social work practice in the health field, New York, National Association of Social Workers, 1961.
82. Bartlett had earlier written the equally influential work, Some aspects of social casework in a medical setting. New York, National Association of Social Workers, 1940.
83. "The author who has contributed most in this respect is the American medical social worker, Harriett M Bartlett, and much of the following discussion reflects her influence." Zofia Butrym, Social work in medical care, London, Routledge and Kegan Paul, 1967, p. 3.
84. Bartlett, Social work practice, op. cit., note 78 above, pp. 268-9.
85. Ibid., p. 18.
86. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
87. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
88. Ibid.
89. For a more detailed account of almoners' impact in this area, see Rona Ferguson, 'Support not scorn: the theory and practice of maternity almoners in the 1960s and 1970s', Oral History, 2003, 31 (2): 43-54.
90. Testimony from interview GCU/CCH T001 Almoners, GCU Archives.
91. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
92. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
93. See Maureen Willis, 'Woodside Health Centre social work', Health Bulletin, 1973, 31 (3): 144-7.
94. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
95. The same applied to Psychiatric Social Workers. "No, I can't remember any men PSWs - there may have been in England, certainly in Scotland I can't remember any men PSW's. I think there were one or two in England." Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
96. Testimony from interview GCU/CCH T003 Almoners, GCU Archives.
97. Testimony from interview GCU/CCH T010 Almoners, GCU Archives.
98. Testimony from interview GCU/CCH T016 Almoners, GCU Archives.
99. 'The medical social worker in Scotland', transcript of a witness seminar held in Library of Glasgow Caledonian University, 13 March 2004.
100. Ibid.
101. Jacqueline Jenkinson, Scotland's health, 1919-1948, Bern, Peter Lang, 2002.
102. M Dupree, Towards a history of the NHS in Glasgow and the west of Scotland', in Chris Nottingham (ed.), The NHS in Scotland: the legacy of the past and the prospect of the future, Ashgate Press, Aldershot, 2000, pp. 138-49, on p. 140.
103. John Stewart, 'The National Health Service in Scotland, 1947-1974: Scottish or British?', Historical Research, 2003, 76 (193): 389-410.
104. Ibid., p. 389.
105. Ian Levitt, Poverty and welfare in Scotland, 1890-1948, Edinburgh University Press, 1988.
106. David McCrone, 'Towards a principled society: Scottish elites in the twentieth century', in Tony Dickson and James H Treble (eds), People and society in Scotland. Volume 3,1914-1990, Edinburgh, John Donald, 1994, pp. 176-200, p. 198;
107. Stewart, op. cit., note 99 above, p. 400;
108. R J Findlay, 'Scotland in the twentieth century: in defence of oligarchy?', Scottish Historical Review, 1994, 73: 103-12, p. 110.
109. Eileen Younghusband, Social work in Britain 1950-1975: a follow-up study, London, George Allen and Unwin, 1978, vol.1, p. 250.
110. Report of the Departmental Committee on the Probation Service, Cmd 1650, Edinburgh, HMSO, 1962;
111. Report of the Committee on Children and Young Persons, Scotland, Cmd 2306, Edinburgh, HMSO, 1964.
112. Social work and the community, Cmd 3065, Edinburgh, HMSO, 1966.
113. Younghusband, op. cit., note 103 above, p. 251.
114. Ibid., p. 252;
115. and Social work and the community, op. cit., note 105 above. By the time of the creation of the big regional social work departments after local government reorganization in 1975 nine of the twelve directors of social work were actually qualified social workers.
116. Younghusband, op. cit., note 103 above, p. 252.
117. Derek T Carter, 'Attitudes of medical social workers towards reorganization', Br. J. Social Wk, 1971, 1 (3): 255-76.
118. One view had it that social work which had been "constructed on an enormous landmass of consensus . . . suddenly in 1980 it appeared to be perched on a tidal sandbank", Bill Jordan and Nigel Parton, 'Introduction', in Bill Jordan and Nigel Parton (eds), The political dimensions of social work, Oxford, Basil Blackwell, 1983, pp. 6-7.
119. 'The medical social worker in Scotland', transcript of a witness seminar held in Library of Glasgow Caledonian University, 13 March 2004.
120. Ibid.
121. See, for example, McDougall, 'Whither medical social work?', Medical Social Work, 1970, 22 (10): 24-5: "the social worker in the local authority can develop a professional relationship to clients appropriate to the circumstances which is far more meaningful to the client than the pseudo-freedom in the secondary setting of the hospital where the very nature of the hierarchical structure detracts from the professional freedom of non-medical staff." A study for the Institute (Majorie Moon, The first two years, London, Swale Press for the Institute of Medical Social Workers, 1965) had interviewed newly qualified MSWs in their first years of practice and concluded that the training had failed to equip them for the difficulties of working with medical staff. Zofia Butrym produced a critical study of the work of the large MSW department in the Hammersmith Hospital in 1968. Individuals had excessive case loads, spent too much time on administration, and could not find enough time for discussions with medical and nursing staff. The lack of understanding of the social work role on the part of the clinical staff resulted in a poor use of the referral system and a good deal of unmet need.
122. Zofia Butrym, Medical social work in action, Occasional Papers on Social Administration, No. 26, London, G Bell, 1968, pp. 57-68.
123. Helen Bate caught this mood and illustrated the vulnerability of the medical social workers to the appeals of a different kind of social work. "Is it too much to ask that we should sometimes have something to say on a larger and more constructive scale?" Helen A Bate, 'The basic task of social work in hospital today', Medical Social Work, 1970, 22 (10): 352-5.
124. Testimony from interview GCU/CCH T001 Almoners, GCU Archives.
125. Many difficulties were caused by high expectations not being matched by enough trained workers: "At the time of the setting up of the social work department we had only about a thousand professionally trained social workers - sorry a thousand trained social workers in the whole of Scotland. And by training - that included people that just now would not be thought of as half trained in current standards. So we were very thin on the ground", David Colvin, 'The medical social worker in Scotland', transcript of a witness seminar held in Library of Glasgow Caledonian University, 13 March 2004. According to the Social Work Services Group there were in 1968, 959 local authority social workers of whom 292 held a professional qualification. This included Probation Officers but not, of course, medical and psychiatric social workers. By 1974 the total was 2,185, of whom 1,122 were trained. Younghusband, op. cit., note 103 above, p. 252. As a comparison, in 2004 there were 7,000 fully trained social workers in Scotland, British Association of Social Workers, press release, 30 June 2004.
126. Testimony from interview GCU/CCH T010 Almoners, GCU Archives.
127. Peter Leonard, 'Social change and the social work profession', Medical Social Work, 1968, 21 (3): 64-9. p. 68.
128. It is important to remember that casework had always had its opponents. See, for example, Barbara Wootton, Social science and social pathology, London, George Allen and Unwin, 1959, pp. 276-81.
129. See, for instance, Ray Lees, 'Social work, 1925-50: the case for a reappraisal', Br. J. Social Wk, 1971, 1 (4): 371-9, who argued that accounts of past practice were frequently over simplified. For a history of what social casework meant in the context of professional developments in the USA,
130. see Roy Lubove, The professional altruist, Cambridge, MA, Harvard University Press, 1965, pp. 113-17.
131. 'The medical social worker in Scotland', transcript of a witness seminar held in Library of Glasgow Caledonian University, 13 March 2004.
132. The depth of the hostility of the radical social worker towards the medical profession and those who were prepared to work with it, is sometimes difficult to appreciate. See Paul Bywaters, 'Social work and the medical profession - arguments against unconditional collaboration', Br. J. Social Wk, 1986, 16 (6): 661-77. In addition to recounting the familiar complaints - that MSWs could be seen as doctors' handmaidens and that doctors contributed articles to medical social workers' journals - Bywaters argued that "few social workers have taken the position that social work may have a contribution to make to health quite independent of the medical profession, or that social workers may need to work actively to oppose current forms of service or to join with others to roll back the domination of medicine and its commercial and professional allies" (p. 675). Butrym replied, taking the author to task for his failure to appreciate that medical social workers had asserted "social work values in their practice in both hospitals and other settings".
133. Zofia Butrym, Letter to the Editor, Br. J. Social Wk, 1987, 17 (3): 305-6, on p. 305.
134. Testimony from interview GCU/CCH T001 Almoners, GCU Archives.
135. 'The medical social worker in Scotland', transcript of a witness seminar held in Library of Glasgow Caledonian University, 13 March 2004.
136. Testimony from interview GCU/CCH T001 Almoners, GCU Archives.
137. See, for example, Nicky Hart, The sociology of health and medicine, Ormskirk, Causeway, 1985, a widely used text which retailed the new conventional wisdom. "In present day Britain, it is difficult for most people to separate their ideas about health from their ideas about medicine. This is because the medical profession has successfully persuaded us that our personal health depends upon high standards of medical care." "Medicine has not made a significant contribution to improving people's health in the past and much of the treatment carried out in the NHS today has never been carefully evaluated" (pp. 7-8).
138. Butrym, op. cit., note 121 above, pp. 305-6.
139. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
140. Testimony from interview GCU/CCH T013 Almoners, GCU Archives.
141. Testimony from interview GCU/CCH T001 Almoners, GCU Archives.
142. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
143. Ibid.
144. Testimony from interview GCU/CCH T001 Almoners, GCU Archives.
145. Testimony from interview GCU/CCH T010 Almoners, GCU Archives.
146. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
147. Ibid.
148. Testimony from interview GCU/CCH T016 Almoners, GCU Archives.
149. Testimony from interview GCU/CCH T014 Almoners, GCU Archives.
150. Testimony from interview GCU/CCH T012 Almoners, GCU Archives.
151. Testimony from interview GCU/CCH T015 Almoners, GCU Archives.
152. GRI, Department of Social Work, report to Board of Managers, 1972, Greater Glasgow Health Board Archive, HB 14.12/1-14.