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9
medical profession, having matured over some thousands of years, could give
helpful advice. Even in Britain, where everyone can have their "single door",
i.e. the National Health Service general practitioner, the average patient, from
any rank of wit or wealth, tends to seek advice from as many sources as possible,
a private doctor, a medical friend, a straight-forward quack, the chemist shop,
a neighbour or granny and continues until he (or she) gets the advice he wants,
(remember that in Britain anyone can practice medicine, provided they do not
pretend they are qualified, do not treat certain diseases or sign certain certificates).
If the medical profession, with its authoritarian attitude, cannot ensure
a "single door", what hope have the social workers, with a far more permissive
approach?
Anyway, the problem exists, and to minimise its repercussions, we have
instituted in the Health and Welfare Department a Social Work Case Register,
after discussion with the main social work agencies in the borough. It is really
an index, with only name and address of the client and the agency, or agencies
involved. Social workers are asked to help compile by sending details as they
arise, and social workers are aware that by writing or phoning, they can be
informed who else is dealing or has dealt with the case, and nothing more. The
register now contains over 5000 names, of these 279 are served by more than
one agency within the Health and Welfare Department, in 139 cases are involved
agencies other than in our own department. In 11 cases five or more agencies
are implicated. Of the social workers in the town the psychiatric social workers
and probation officers have refused to co-operate on the grounds of confidentiality
(thereby enjoying the luxury of complaining that too many agencies are
concerned and failing to do anything about it!). Confidentiality carried to
extremes, where it is neither in the interest of the client or community,, is a
religion which some social workers share in common with many of the medical
profession.
So far, enquiries, a few dozen in about six months, have been disappointing.
Strangely enough, some of them have come from hospital P.S.Ws who refuse
to add the names of their own clients.
Training
A term bandied about in Social Workers training is "generic", indicating
that there is a common basis before specialisation. In professions this is
nothing new, as of course all medical men be they surgeons, psychiatrists or
regional hospital board administrators, have a "generic" training before qualification.
(We share much with the social workers, including a mistaken idea
that professional identity is paramount above functional dispersal; in our case,
the demand that the three National Health Service sections of the medical
profession should be joined in an area health board!). To enable this type of
training to be locally effective, the Health, Welfare and Childrens Department
are probing the possibility of a joint training officer and to this end we have
already had discussions with the Home Office and London Boroughs Training