Organisation of the Almoners Department – Birmingham Accident Hospital

Based on information available 1948:

Almoners (now known a social workers) were key staff at the Acci
The Acci Almoners regards medical-social work was the art of helping people, both through the best use of their capability and through the resources of the community to overcome personal and social difficulties and to achieve the fullest possible measure of health and independence
The department consisted of three Almoners and two clerks. In addition, there was nearly always two Almoner students training at the Acci – who spent their time observing and undertaking medical-social casework
Always were specifically attached to each of the three teams and were available for advice in casualty, outpatients and dressings stations. In addition, an Almoner was allocated to work in the Burns Unit
The outpatient work of the Almoner came through three mechanisms of referral:
from the Rehabilitation Department
Referred by the doctors
From other sources

The Rehabilitation Department

All patients who attended the Rehabilitation Department were sent automatically to the Almoner when they first attended to see the Rehabilitation Officer. The patients were sent with an information slip with details of their name, injury, probable length of duration of treatment, treatment and time
The role of this initial consultation with the Almoner was to ensure the patient could attend regularly, and if there were difficulties help to overcome them
One common problem was transportation fares (bus or train). For example a man on workman’s compensation with a wife and two children under 14 would probably have a total income of £2.10.0 (old money) fares of 9d a day, six days a week amounted to 4/6, which seems little until the fact the patient is on a vastly reduced income compared to their normal salary. The total fares represented about 9% of his total income for 4 people
Other difficulties besides problems in relation to attendances may have been brought to light
It may be there is nothing for the Almoner to do but it was her job to ask a few well-chosen questions and to send the patient away with the feeling their time as not been wasted and with the knowledge the Almoner is always there to help
Should the patient not be fit enough to attend the Department (as an outpatient) they could be interviewed in the patients lounge
Interviews were recorded on a social card which were also used as a central index of activity

The Almoner in the Rehabilitation Clinic

The Almoner attended every rehabilitation clinic having previously met the patients on their initial referral. All patients had a social card with all relevant details. These cards were collected from the departments clerk office before each clinic
With some knowledge of the patients there was an opportunity for the Almoner to discover the surgeons wishes and to ask or give advice where there appeared to be some social problem in relation to the patient’s injury
The key point for the patient’s benefit was the Almoners working with each surgeon

From the Surgeons

Outpatients were also referred to the Department for many reasons by the medical staff
There was a two way exchange of information between the Almoner and the surgeon of relevant information and outcomes, for example could a girl living in lodgings who is to have complete rest at home with a septic leg be able to do so

From other sources

This included self-referral, from the industries for which they worked, by the ambulance person who bring them to the hospital, from personnel in the hospital who hear of their problems and suggest they talk to the Almoner etc

Inpatients

Almoner attached to each team to manage both inpatients and outpatient work
Burns Unit has its own dedicated Almoner responsible for both inpatient and outpatient referrals
Each day list of admission and discharges are sent to Almoners Department and from these the social card made for each patient and passed to the Almoner concerned
Policy to see each patient at least once whist an inpatient or in the case of children or very sick patients see the relative
The purpose of seeing the patient can be summarised as follows:
To make the patient aware there is some in the field of medical-social work who will be willing to come and see them at any time to discuss concerns
To advise and help with immediate problems which may be identified at interview
Obtain certain basic information that, coupled with diagnosis, will give some indication as to whether the patient is likely to encounter difficulties in the near or distant future. Identified problems will be kept under review. Further information may be gathered from the ward sister or discuss problems and plans with the treating surgeon for example – two women aged 62 admitted with fractured femur. In the first case the Almoner ascertained the patient is married, her husband is in regular work and they have a married daughter and her husband with no children living with them. The injury was sustained when she slipped in the home. There would appear to be no problem here, the income continues, and the daughter will look after the home and the patient on her return home. In the next bed is a woman aged 62 again with a fractured femur. She works as a cleaner in a factory and is single, she lives with her brother who is in indifferent health and irregular work. She sustained her injury whilst standing on the edge of the road and a car hit her. The Almoner can see no immediate problem other than the patient clamouring to take legal action against the driver who she feels has temporarily removed her means of livelihood. This being so she needs legal advice. From a longer term perspective there will be a problem with ongoing care post discharge and the probable requirement for a convalescent home. Here financial position will be challenging and then optimistically her return to work. She will require advice and help with all of these

Records

All patients have a basic social card – where necessary more comprehensive and further notes are created which are maintained in the patients notes

Statistics

The social card had a code round its perimeter and staff punched the relevant holes in order to complete statistics essentials. The main headings were:
Sex distribution
Type of accident
Source of referral
Occupation
Voluntary and statutory organisation used in their care

Medical-Social Work

The primary responsibility is as previously defined – the treatment and rehabilitation in relation to the patient’s current problems. this is always her prime duty
Pre-existing problems may come to light which morally cannot be ignored. Assistance will be given, not action to resolve these issues which will not take precedence over her primary duty

Appliances

Under the new Health Act appliances are free of charge. At the Acci a clerk within the Almoners Office were responsible or ordering and supplying appliances

The Almoner had overall responsibility for the service

Convalescence

Attempts are added to choose a convalescence home most suited to the patient diagnosis and from an environmental point of view for example chest cases responded particularly when sent to South Coast Resorts
Certain homes have expertise in handling difficult or educationally backward children

Return to Work

The Almoner worked relentlessly to ensure a close and strong tie with industry and the patient particularly the Personnel Department that so often carried the responsibility for the more human problems of the worker

Additional Work

The Almoner maintained their place on committee and other public bodies undertaking social services in the area from which the patient would benefit
The department maintained a certain amount of teaching to various student courses and bodies
The department was represented on the local Disablement Advisory Committee
We hope by overcoming personal and social difficulties will achieve the fullest measure of health and independence