Social work with adults experiencing complex needs: summary of NICE guidance

Dear Editor

We applaud that National Institute for Health and Care Excellence (NICE) published a new evidence-based guideline [1] on social work with adults experiencing complex needs to support integrated care between general practitioners and social workers. As a helping profession, social work aims to enhance people’s well-being and health and help meet their basic needs. Social workers “can be involved in all aspects of a person’s care” [2], especially social care services, and contribute to health and healthcare of patients experiencing complex needs through collaborating with general practitioners and other primary care professionals in multidisciplinary teams.

In serving patients experiencing complex needs, the guideline [1] made recommendations that social workers should follow basic principles of their professional practice (e.g., being non-judgemental to people’s and their family’s circumstances), conduct needs and risk assessment, provide individual or family casework, help people develop social connections and reduce isolation, support people’s plan for the future, respond to their urgent needs, and build strong communication and collaboration with multidisciplinary teams.

These recommendations encompass a completed process of classical social work interventions, mainly emphasizing social workers’ clinical and psychological functions. It seems that the guideline might be further enhanced by also explicitly stressing social workers’ functions on “financial” care ----that is, social workers can help individuals and families access to public welfare benefits and community resources, and support individuals and their families to meet financial obligations and basic needs, absorb negative financial shocks, plan for long-term financial future, and achieve their financial well-being [3]. Such “financial” care needs are intrinsically linked to people’s health and healthcare.

Not to leave out social workers’ “financial” care for health is particularly important during the cost of living crisis in the aftermath of the COVID pandemic [4-11]. Patients experiencing complex needs often suffer from disadvantaged socioeconomic status, and their economic circumstance and financial insecurity could be even worse in the crisis, in need of food, transportation, housing, and others. Their financial status could be greatly improved with the support of public benefits and social work practice.

In addition, general practitioners and other primary care professionals need social workers’ support to address clients’ “money” problems. General practitioners and other primary care professionals may have limited trainings, skills, and resources to pay attention on this subject and discuss the “money” problems in an appropriate way [12]. Since the initiation of the profession in the early 20th century, social work practice has deep roots in supporting families’ finances (such as budgeting, saving, and linking clients to a variety of economic resources) and improving their financial well-being and health [3]. Understanding families’ financial needs, social welfare benefits, and community resources, social workers are in a unique position to connect clients to the recourses they need.

When we pay a close attention to this new guideline, we clearly see the importance of “financial” care needs throughout the report [1]: it is part of the goal of social work practice for people’s well-being (e.g., economic wellbeing); it is one root determinant of health inequalities discussed in the report (e.g., social-economic status); and it actually is one parameter defining the literature search strategies the NICE guideline committee applied to obtain best social work practice evidence. The cost of living crisis is another clear and important reminder that “our health is shaped by our environment” [10], and is socially and economically determined. When we include social work practice in integrated care, social workers can help our clients meet their “financial” care needs.

References

1. National Institute for Health and Care Excellent. Social work with adults experiencing complex needs. https://www.nice.org.uk/guidance/ng216
2. Mehmeti A, Francis J, Dworzynski K, Lioyd-Evans B. Social work with adults experiencing complex needs: summary of NICE guidance. BMJ 2022: 377:o1077. https://doi-org.libproxy.wustl.edu/10.1136/bmj.o1077
3. Sherraden MM, Huang J. Financial social work. Encyclopaedia of social work. https://doi.org/10.1093/acrefore/9780199975839.013.923
4. Andersen K, Reeves A. The cost of living crisis is harming mental health, partly because of previous cuts to social security. BMJ 2022;377;o1336. http://dx.doi.org/10.1136/bmj.o1336.
5. Iacobucci, G. Rising cost of living is damaging people’s health, says royal college. BMJ 2022;377;o1231. http://dx.doi.org/10.1136/bmj.o1231.
6. Limb M. Cancer patients’ health is at increased risk from cost of living crisis, charity warns. BMJ 2022:377:o1103. http://dx.doi.org/10.1136/bmj.o1103.
7. Patrick R, Pybus K. Cost of living crisis: we cannot ignore the human cost of living in poverty. BMJ 2022:377:o925. http://dx.doi.org/10.1136/bmj.o925.
8. Limb M. failure to protect cost of living will increase poverty and health inequalities, warn analysts. BMJ 2022:377:o794. http://dx.doi.org/10.1136/bmj.o794.
9. Pollard T. food bank use is a canary in the coal mine for mental health services. BMJ 2022:376:o759. http://dx.doi.org/10.1136/bmj.o759.
10. Goodwin S. food aid charities fear the worst as the cost of living crisis takes hold. BMJ 2022:376:o416. http://dx.doi.org/10.1136/bmj.o416.
11. Goddard A. The cost of living crisis is another reminder that our health is shaped by our environment. BMJ 2022:377:o1343. http://dx.doi.org/10.1136/bmj.o1343.
12. Salisbury H. Health, poverty, and stigma. BMJ 2022;376:o116. https://doi.org/10.1136/bmj.o116.