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The relationship between professionals of different disciplines in the Health and Social Services has long been problematical. Issues of control and responsibility have concerned medical and non-medical staff alike. The establishment of generic social work departments, post Seebohm, has gone some way towards equalising the power balance as far as social workers are concerned. However, although the independence that they thereby acquired has arguably been beneficial to their working practices and to their identity as a separate professional group, it would be misleading to suggest that this has made the basic problem disappear. Indeed it might be contended that the underlying emotional issues have only been avoided and still have to be dealt with by each individual worker in the field. More recently it has become apparent that the nursing profession has been trying to come to terms with some of the same issues by organisational means.
For three years I was able to work with a team at Littlemore Hospital, Oxford, which comprised social workers, senior and junior psychiatrists, psychologists, two psychiatric nurses and a hospital chaplin who is also a trained analyst. The specific focus of this team was the G. P. attachment which each team member undertook. This brings us immediately to another important area since the relationship of outsider to general practitioner does itself require delicate negotiation. However it will be useful to describe the setting in which the team was based.
The Ashhurst clinic is part of Littlemore Hospital in Oxford. The building itself is divided into a small in-patient unit, some administrative and social work offices and a day unit. It is to the last of these, the day unit, that I am referring.
The day unit offers an intensive three-day-a-week programme to individuals who present with problems ranging from borderline psychosis to severe emotional difficulties expressed as problems with living. The programme is designed to be rig