Social Work History at Royal Adelaide Hospital

Social Workers at the Royal Adelaide Hospital have a long and distinguish history. They were originally called Almoners, reflecting the fact that they were the liaison between the hospital and the poor in the community.  This article will explore the history of the Royal Adelaide Hospital Social Work Department from 1937 to 2000.

The Beginnings

Social Work as a profession, began to develop in Australia during the late 1920’s. The first official Australian Tertiary Course, was the Victorian Institute of Hospital Almoners, established in 1929. However, it wasn’t until 1936, when Miss EG Lupton, Head Almoner at the Moorfield Hospital, London, gave a lecture at the Adelaide Hospital, that the Adelaide Hospital showed any interest in employing Almoners.  

The lecture by Miss Lupton set wheels in motion. On the 8 January 1937, the Chief Secretary finally approved the appointment of an Tuberculosis Almoner.   She was to receive a salary of 300 pounds per annum for initially a term of two years.

Applications for the position of Almoner closed on the 30^th January. The Chairman reported that 18 applications had been received for the position of Almoner; there was only one qualified Almoner among them, viz: Miss MT Noall. The Secretary had made enquiries from the Alfred Hospital, Melbourne, where Miss Noall had held the position of Almoner for two years and had received a very satisfactory report; they stated they could not speak too highly of her. Resolved to recommend the appointment of Miss MT Noall as Almoner.

Adelaide Hospital Board Minutes, 4 February 1937

Mary Noall was one of the first graduates of the Victorian Institute of Almoners in 1930. In that same year she also qualified as a Health Inspector from the Royal Sanitary Institute.  Mary travelled to London obtaining the Certificate of the British Institute of Almoners. She then did further training at St Thomas’s Hospital before being appointed to the [Royal] Adelaide Hospital Chest Clinic to assist tuberculosis patients and their families.  Dr Darcy Cowen, Tuberculosis Clinic Director strongly supported the appointment, based on his previous experience with Almoner’s in England.  Mary’s position was important in assisting to manage the economic and material issues of tuberculosis patients and their families.

Resolved to recommend that a sum of 20 pounds be placed at the disposal of the almoner for the purchase of surgical appliances, such as surgical corset and leg splints, for which she has been in the habit of paying cash out of her own pocket and trusting to the patients to repay her by weekly instalments. The Board did not consider this a satisfactory arrangement and decided that the Commissioners of Charitable Funds be asked to vote the sum of 20 pounds to be place in a Savings Bank account to be operated by the Almoner and the Lay Superintendent conjointly.

Adelaide Hospital Board Minutes, 7 February 1939

Education

To train to become an Almoner, the student first had to complete a two year Social Work Diploma course and then a further year doing a Medical Social Work course. In Australia, there were five social work training organisations: two (in Sydney & Melbourne) dedicated for medical social work training. The other three (Adelaide, Melbourne & Sydney), were concerned with general social work training.

The advantages claimed for trained social workers over their untrained predecessors or colleagues were many. It was said that they had learned ways of being reasonably efficient in a complex society; they had knowledge of the community’s resources for aid and relief.

RJ Lawrence – Professional Social Work in Australia, 2016

Thanks to the active promoting by Stella Pines, in 1935 saw the formation of the Adelaide Board of Social Service Training; later changed to Board of Social Study and Training in 1937. The Second World War saw an a extreme shortage of trained Almoners. This prompted the Royal Adelaide Hospital in 1941 to write to all Hospital Honorary Staff concerning the establishment of an Almoners course at the Adelaide University. Fully supported by the Honorary Staff, the Board wrote to the Chief Secretary, setting out the proposal and the benefits to the hospital if this scheme was established.

At the same time the Almoner Association was also campaigning and with the University’s support, by 1943, the course had full acceptance of training by the Adelaide University. However, it was not until the end of 1955 that an agreement was reached by all parties.

Early Almoners

Mary Noall worked at the Adelaide Hospital for the next three years before resigning on the death of her father and returning to Victoria in 1940.  She was replaced by Janet Payne, who held the Certificate of the London Institute of Hospital Almoners.  She also had trained at the London School of Economics and St Thomas’s Hospital before working as an Almoner at Radcliffe Infirmary, Oxford for fifteen years.  Her work at Radcliffe Infirmary included:

While on a holiday to Australia, Janet found the Second World War made it impossible for her to return to England, so she worked in various Almoner jobs in Melbourne and South Australia before being appointed to the Adelaide Hospital.

Two years later, the Adelaide Hospital appointed a second almoner, Margaret Mengerson as Assistant Almoner, for the hospital itself (Janet was Almoner for tuberculosis patients).  Margaret gained her Social Service Diploma in Adelaide in 1938 and then graduated from the Victorian Institute of Almoners.  On graduating, Margaret was Almoner at several Melbourne and Sydney Hospitals before working in the Family Welfare Bureau of the Lord Mayor of Sydney’s Patriotic Fund. At the Adelaide Hospital, Margaret worked under the direction of the medical staff and her duties were often a response to the poor living conditions of the patients. 

Although appointed to work as Almoner for the Hospital and not the Chest Clinic, Margaret reported that three-quarters of her time was spent at the Chest Clinic. Dr Cowan, the Physician-in-Charge of the Chest Clinic, had forwarded a written request to the Board, that she be appointed full-time at the Chest Clinic.  The Board approved the appointment and recommended another Almoner be appointed for the Hospital itself.

Not long after this, Margaret requested leave of absence to enable her to be married, however this was not granted and the only alternative was for her to resign.

To replace Margaret, Patricia McLeod (nee Marcus) was appointed Almoner to the Chest Clinic in 1943. She was one of the first three students to receive Adelaide Social Service Diplomas in 1937 and completed the one year medical course from the Victorian Institute of Hospital Almoners. After positions in Melbourne hospitals, she worked at Royal Adelaide Hospital, however after working for only one year, Patricia applied for leave of absence to get married.  Although approved by the Board to continue working at the hospital after her marriage, the Public Service Commissioner denied this and like Margaret before her, Patricia had to resign.

Expansion

Qualified Almoners were slowly starting to increase in number; in 1941, there were six qualified almoners working in various institutions in Adelaide.  These six decided to band together to form the South Australian Branch of Australian Association of Hospital Almoners.  The group allowed only qualified Almoners to join, with its membership and focus almost a duplicate of the requirements of the New South Wales Almoners Association.  By the end of the war, the group had around 60 members, with the majority being single women.

The workload of the Almoners was enormous; the Royal Adelaide Hospital at that time treated approximately 13,000 admissions and 199,000 outpatients annually.  Despite repeated requests over many years from the Adelaide Hospital Board to the Public Service Commissioner for an additional full-time almoner, this did not occur until late 1943. The then Minister for Health, Mr Alexander Lyell McEwin, announced that a third almoner would be appointed to the Royal Adelaide Hospital to include both diabetic and general hospital work.

Margaret Reed was appointed Assistant Almoner at the Royal Adelaide Hospital, 10 February 1943.  Originally from Adelaide, she did the two-year Social Service Course at Adelaide University, before completing the one-year medical almoner’s course in Melbourne. After six months probation she was appointed full time on 22 September 1943.

An almoners job is essentially one of interpretation – of interpreting the hospital patient’s home conditions to the doctor, of interpreting the patient’s medical needs to his family – of putting discharge patients in touch with the agencies, religious, philanthropic, or employment best suited to help them

Margaret Reed, The News Newspaper, 22 February 1943

One of the chief duties and a major difficulty for the Almoners Department was finding suitable accommodation for long-stay patients, particularly those requiring nursing home care.

Report from the Almoner regarding the difficulty in removing chronic cases from the Hospital to a suitable institution. To be referred to the Chief Secretary in connection with the previous correspondence between the Minister and the Board with regard to the responsibility for caring for chronic cases, especially in connection with the original deputation by the Board and also the recent minute urging that the matter be expedited.

Royal Adelaide Hospital Board Minutes, 30 April 1942

Second World War

The Second World War caused additional problems for the Almoner Department.  As well as an increase in demand from returned soldiers requiring assistance, rationing also caused problems and not just with patient care.  The Almoners were responsible for purchasing their own material and making their work overalls. These were worn during the working day and in particular, when going on home visits.  However, with the introduction of war rationing and the supplying of clothing coupons, the coupons available to the Almoners were insufficient.  The request for extra material coupons had to go all the way up to the Deputy Commissioner of Rationing to be approved.

To assist with the large demand from returned soldiers, the Red Cross Society took over arrangements for the sick discharged soldier who didn’t come under the Repatriation Services.  However, if the man needed hospital treatment, the Almoner Department then became involved.  They were the liaison between the patient, the hospital and outside agencies and ensured that the right services received information about the medical and social implications of the patient’s illness.  The demand for appliances such as crutches, splints and wheelchairs, which were the responsibility of the Almoners Department, also tripled in the first two years of the war.

Diabetic patients were also a responsibility of the Almoners Department.  It was the Almoner’s role to not only supply them with syringes etc, but to see, after they left the hospital, that their home conditions, employment, injections etc were managed properly. Experience had shown, that if they were not followed up, the patient would soon be back in the Hospital.  The Almoners also sold the syringe needles to the diabetic patients, as it allowed the Almoners to keep in regular touch with them.

With the large increase in the workload, the Almoner Department was finally given administrative help in 1944:

The Acting Lay Superintendent forwarded a letter from the Almoner, regarding the necessity for the appointment of a Clerk to her section. The Acting Lay Superintendent reported that the work in this section has grown to such an extent and is likely to expand still further in the near future, that he is of the opinion that additional assistance is necessary. Resolved to recommend the appointment of a Clerk

Royal Adelaide Hospital Board Minutes, 22 November 1944

Staff Shortages

The workload situation became worse when Chest Clinic Almoner, Patricia McLeod, resigned in October 1945.  Although the position was advertised locally and interstate, there were no suitable candidates.   By August 1946, the two remaining Almoners in the hospital, were overworked, unsupported and underpaid (when compared to interstate Almoners).  Both handed in their resignations.  Again, the positions were advertised, with no one applying.  Due to the war demands across Australia, there were more positions than qualified Almoners. The Board did consider bringing Almoners from England, however, the expense and lack of available overseas Almoners made this impossible.

As an alternative to fill the positions temporarily, the Board considered appointing Trained Nurses to the Almoners positions. When the Honorary Medical Staff were approached regarding this, they were not supportive of this scheme and it was decided to advertise for Welfare Officers in place of Almoners.

Advertisements were again placed throughout Australia for the positions of Chief Almoner, Assistant Almoner and Welfare Officers and although applications were received for Chief Almoner, they did not have the relevant experience. With regard to the Temporary Welfare Officer positions, there were several applicants, however the Board was limited in their acceptance, as preference had to be given to ex-Service applicants.  The Board appointed Misses Dohnt and Travers, ex-war service personnel, as Welfare Officers and Elinor Wells (nee Jacob) as Assistant Almoner. 

It was not until March 1947, that the position of Chief Almoner was filled by Margaret Sullivan at a salary of 323 pounds per annum. Margaret Rendle Sullivan began studying pharmacy at Adelaide University in 1936 (her father Wilf was a Pharmacist) however changed to Social Work in 1938. 

As the course work for Social Work had only commenced in 1936 in South Australia and this was 1938, I had some very odd placements …  I went to Royal Adelaide Hospital and the Adelaide Children’s Hospital … we wore gloves and hats when sent to visit patients and I also carried an umbrella to fend off dogs who were interested in ankles.” 

Margaret Sullivan, The Timothy Sullivan Website, timothysullivan.com.au

She was awarded her Diploma of Social Work in 1942 and a year later her BA.  After graduating she worked in various temporary social work positions before receiving a Red Cross Society scholarship to the Victorian Institute of Hospital Almoners.  On competition, she worked at the Red Cross until her appointment at Royal Adelaide Hospital.  In 1949, Margaret was one of two Australians chosen to join Britain’s Guide International Service team in Europe to work among displaced persons in the British zone of Germany.  On her return to Adelaide in 1951 she was appointed Senior Almoner to The Adelaide Children’s Hospital, where she remained until her retirement in 1982.

Another appointment at this time to the Almoner Department was Hannah Buckley. She was born in 1917, educated at Loreto College and then went to the newly formed Board of Social Service Training (part of the University of Adelaide) in 1935, becoming one of South Australia’s first trained Social Workers.  She was also the first South Australian Catholic Social Worker, where she ran the Catholic Social Service Bureau in Adelaide from 1942-1947. After leaving Royal Adelaide Hospital, she worked at the South Australian Tuberculosis Association.  In 1959, she was appointed Head Social Worker at Queen Victoria Hospital until her retirement, 16 years later. 

Two more almoners were appointed Royal Adelaide Hospital Chest Clinic and Frome Ward In 1948; Christine Douglas and Frances Kay.  Both Frances and Christine did the two-year Social Work Diploma in Adelaide and then in 1947 went to Melbourne for the Almoners course.  Christine resigned in 1949 when she married Geoffrey Munday. Barbara Garrett (nee Matters) replaced her as Assistant Almoner.

Post War

At this time the hospital was full, with overcrowding occurring in many wards. The situation regarding lack of suitable accommodation for long stay chronic patients became so acute that the Margaret Sullivan sought the Board’s approval to advertise through the daily press for private accommodation for these patients.  This was done using a box number, so that no mention would be made of the hospital. The Board approved and was of the opinion “that such action would assist in relieving the overcrowding position at the hospital in which difficulty is experienced in obtaining suitable accommodation for chronic patients” (Board Minutes 04/06/1947).

The aftereffects from the Second World War continued to impact the Almoners Department.  The demand for crutches increased dramatically and in 1948, the Chief Almoner reported that she had inspected 90 pairs of crutches available from the Supply and Tender Board ex-Disposals, and recommending their purchase.  By September 1949, the shortage of crutches and walking sticks for patients was so chronic, that the Almoner asked permission for an appeal to be lodged in the press and on-air:

Frome Ward was the acute ward for long-term tuberculosis patients.  Christine Douglas introduced a handicraft service for in-patients in Frome Ward to assist in relieving the tedium of hospital life. Once a week, ex-servicemen trained in handicrafts by the Red Cross, instructed patients in the making of felt animals, wool rugs and tapestry.  “The medical and nursing staff noticed a happier atmosphere and greater cooperation in the ward when the patients were interested in some definite occupation” (Board Minutes 21 January 1948). 

When Almoners were required to do home visits, their means of getting around was on public transport, which was a time-consuming exercise.  The Chief Almoner asked that in order to perform their work more efficiently would they be allowed to use taxi’s.  Although, the request was submitted to the Minister of Health for permission, taxis were only approved for urgent or special cases; the Almoners continued to use buses and trams.

In 1949, the main duties of the Almoners Department (Annual Report 1949) were:

1. Appliances;
2. Aftercare medical treatment – includes helping the patient be admitted to hospital, or cared for at home with the help of a District Nurse or an emergency housekeeper;
3. Accommodation – request for adequate housing for patients living in unhealthy, congested living conditions and for aged care facilities. Demand for vacancies far exceeds the supply;
4. Transport – to and from appointments;
5. Financial Assistance – including assistance with fares, extra nourishment, appliances and transport. One-third of referred patients are pensioners; and
6. Foreign Migrants – these patients often need more of the Almoner’s time than usual due to language difficulty and general ignorance of procedures.

Cancer Clinic Almoner

By the beginning of 1950, the Almoner’s Department consisted of four Almoners: Margaret Sullivan (Senior Almoner), Assistant Almoners: Christine Douglas, Frances Kay, Hannah Buckley and a clerical assistant. In the same year, the Royal Adelaide Hospital appointed its first Almoner to the Cancer Clinic: Dorothy Pearce. Dorothy was the former Director of Welfare Service at Adelaide Red Cross headquarters and also the president of the SA Branch of the Australian Association of Almoners.

Dorothy was appointed by the Anti-Cancer Campaign Committee along with a Stenographer (Miss Dunstan) and a Clerk (Mrs Goodhart). Initially they came under the control of the Anti-Cancer Campaign Committee.  Accommodation was found for her on the verandah at the entrance to the Radiotherapy Department, where one bay was enclosed.  However, as she was treating hospital patients and Royal Adelaide Hospital was providing office furniture and equipment, the Royal Adelaide Hospital Board arranged to transfer Dorothy to come under the Public Service Act.  It was agreed:

that the Almoner engaged by the Committee should be included in the staff of the Hospital Almoner Dept, so that her services may be utilised for other purposes if the work of the Cancer Clinic permits of this being done. 

Royal Adelaide Hospital board Minutes May 1950

However, Dorothy objected to being brought under the Public Service Act. The Anti-Cancer Campaign Committee was willing to continue payment of her salary, so although Dorothy worked at the hospital, she remained the responsibility of the Committee.

1950s

The Almoners Department was located on the second floor of the Outpatients Department.  The room available was cramped, poorly illuminated and ventilated.  Despite repeated requests from the Almoners to rectify the situation, it was not until 1958, that sketch plans were prepared by the Architect-in-Chief’s Department to provide a temporary Almoner Department on the second floor between the Outpatients Department and Casualty, with the existing Almoners offices being retained for use of the Assistant Senior Almoner and students. However, this did not go ahead due to the large-scale redevelopment of Royal Adelaide Hospital in the 1960s.

The poliomyelitis outbreak in 1950/51, added additional strain to the Almoner Department, with an overall 240 extra polio cases The acute patients were sometimes admitted to the hospital, however the the majority were referred as in-patients at Hamsptead’s Northfield Wards (which were now under the control of Royal Adelaide Hospital).

During the outbreak, the Almoners regularly visited Northfield to endeavour to cope with the many needs of these patients. The Almoners provided assistance for appliances, financial aid, transport, placement of children, domestic help, after care, housing, rehabilitation and help with employment, as well as general advice and friendly support.   Polio cases, for the next couple of years, continued to take a large portion of the Almoners time, as nearly all of the patients required several appliances, and a great number required extensive help in planning their future employment.

Other duties of the Almoner Department at this time included interviewing applicants for financial assistance with glasses. In 1951, 896 people were interviewed for glasses alone. Also, 579 diabetic patients were supplied with syringes and needles and received follow-up visits. Splint assessment, was another time absorbing activity for the Almoners. However, by 1953, this had been delegated to a Clerk, allowing Almoners to work more closely with the medical staff to give the patients a more comprehensive case work service. 

Two new Almoner Assistants were appointed in 1951, Elizabeth Hicks and Eva Winter, after they passed the final of the Melbourne Almoner’s Course.

Carrying over from the last decade, the ongoing problem of inadequate care for aged patients and the chronically sick continued.

Every week elderly people are referred to the Almoner Department and because of their lack of money and the lack of vacancies in suitable homes, very little can be done for them. Usually, they are forced to return to unsuitable living conditions. The cheapest nursing home fees are now in the vicinity of seven pounds seven shillings per week and the old age pension of three pounds per week is quite inadequate, even with hospital benefits added.

Royal Adelaide Hospital Annual Report, 1952

Almoners were also providing monthly introductory talks to new groups of trainee nurses, at the request of the Sister Tutor and the University of Adelaide Department of Social Science continued to send Social Work Students for supervision and training. There were usually two students allotted each term. The Senior Almoner also gave lectures at the University to both Social Work and Medical Students  Among the students at this time, gaining Almoner work experience at Royal Adelaide Hospital, was Princess Sao Papharvadi, a member of the Royal Family of Burma.

National Health Act

The passing of the National Health Act (Commonwealth Health Scheme) by Parliament in 1953 allowed the provision of free pharmaceutical, sickness, dental and hospital services.  This had a marked effect on Royal Adelaide Hospital Almoner Department, removing the barrier to patients in meeting hospital fees. The Almoners now spent less time on assisting with patient finances.

Almoner statistics were beginning to show that while new patients were continually being referred, there were still a large portion of patients still requiring assistance from previous years.  In 1954, 3344 patients were seen in the department.  Of those, 1036 were carried over from previous years, with the greatest number of new referrals (1940) coming from the Outpatients Department.

During the 1950’s, Almoners were becoming more involved in caring for paraplegics.

It is desirable that these patients have expensive equipment such as wheelchairs (which they are, wherever possible, helped to obtain) and be trained for future employment. With this group of patients, as with those with poliomyelitis, much time is spent trying to help them accept their crippled condition, and see the future in positive terms, and not as that of invalids with no useful place in society

Royal Adelaide Hospital Annual Report 1954

Community Organisations

Almoners at the hospital did not work in isolation but liaised closely with other organisations. The DaCosta Samaritan Fund assisted to help meet the cost of spectacles and surgical appliances; the South Australian Hospital Visiting Committee gave donations towards the costs of artificial limbs and wheelchairs and paid for young children to be cared for while their mother’s were in hospital.

The Children’s Welfare and Public Relief Department assisted indigent patients with fares to attend the hospital and paid for special food for those on hospital diets. Similarly, the Red Cross Society assisted the hospital and patients with voluntary transport for appointments. The majority of the patients helped were pensioners or people on low incomes For these people to receive the appropriate services, this took up a lot of valuable Almoner time.

Another difficulty that the Almoners Department faced at this time, was the enormous delay in obtaining artificial limbs. When limbs were purchased from the Repatriation Department Limb Factory there was usually a delay of around five months for delivery. The hospital asked the Repat Commission to extend priority to the Royal Adelaide Hospital, however this was denied.

It was the practice for the Almoner to require up to 70% of the full cost of the limb to be deposited with that department prior to placing an order. It was also necessary that the balance be paid at the time the account is rendered. The Almoners’ Department was finding it increasingly difficult to pay the account when rendered and to thereby finance a time payment system in that the patient pays the balance to the Almoner over a period of time

Royal Adelaide Hospital Board Minutes, 1954

As well as looking after patients at the Royal Adelaide Hospital, the Almoners would do weekly visits to Northfield and Magill Wards and in 1955 started regular visits to St Margaret’s Convalescent Home. In 1939, the Magill Old Folk’s Home came under the management of Royal Adelaide Hospital. The hospital used the site to care for chronic cases (nursing home and cancer patients) to help relieve the overcrowding occurring in the wards.

Almoner Scholarships

When Welfare Officer, Miss G Travers, who had been working at the hospital since 1946, completed the Adelaide Diploma of Social Science, she was eligible to do the interstate Almoner course. She applied to the Hospital Board for study leave and whether the Board would be prepared to grant a scholarship for interstate training:

“The Medical Superintendent recommended that in view of the service record and abilities of Miss Travers, consideration be given to a grant to enable her to complete an Almoner’s Course in Sydney. He also mentioned that advertisements throughout Australia for Almoners had appeared on two occasions, but no applications had been received.  In view of the Commonwealth-wide shortage of Almoners he considered the matter of training and employment of Almoners should be taken up with the appropriate organization and consideration given to the following: _{(Royal Adelaide Board Minutes, 18 October 1954)}:

1. The employment of Social Workers at the Hospital be on the understanding that on a future date to be determined, the appointees will proceed interstate with financial assistance to complete their training. On return to the service of this hospital as an Assistant Almoner, they would be required to serve the hospital for a specified minimum length of time;
2. That Almoners be granted professional status in the service; and
3. That consideration be given to establishing a training school in conjunction with the University.

After discussion, it was resolved to:

1. To request financial assistance of a grant of 400 pounds for Miss Travers to enable her to complete her course in Sydney; and
2. To write to the Minister urging the Government to take up with the University the early need of establishing a course for Almoners and that an attempt be made to do this early in 1955.

On completion of the Almoners Course, Scholarship holders were required to serve two years at Royal Adelaide Hospital.

The Board also granted another Scholarship the following year to enable Frances Cashel, a recent Social Science graduate, to qualify as an Almoner. The shortage of Almoners continued to be acute throughout Australia.

Adelaide Almoner Course

Due to the shortage of Almoners, the University of Adelaide and the Royal Adelaide Hospital were in negotiations to establish a Medical Almoners Course in Adelaide. By the end of 1955, agreement was reached between both parties with the following recommendations approved:

1. That the course for the Diploma in Social Studies be rearranged to extend over three years and that the extended course operate from 1957;
2. That arrangements be made to enable students taking the diploma course, after graduation in Arts or Economics, to complete the course of study for the diploma in 2 years; and
3. That in the third year of the 3-year diploma course, or in the second year of the post-graduate diploma course, provision be made for such training in medical social work as will make possible registration with the Almoners Institute; this course to be available in Adelaide in 1957. This will be provided at the Royal Adelaide Hospital.

However, for this to be achieved, the hospital needed additional Almoners on its staff.  Application was made by the Hospital Board to the Minster for extra funding for two more Almoners: one for general casework, and one for student teaching.

In 1958, the first Medical Social Work Students began attending the Royal Adelaide Hospital (six additional students in the first intake and ten the following year). Very quickly problems occurred in the already overcrowded hospital.  The students required: rooms for clinical study and writing up of notes; offices for the Assistant Senior Almoner, who was responsible for the students; tea and dining facilities (at this stage each area had their own tearoom, there were no communal cafeteria); restroom facilities including lockers or place to hang their winter hat/coat, store handbag etc. It was a juggling act – one morning the students could be scheduled to use the Ear Nose and Throat Outpatient area and in the afternoon they could be found in the Gynaecological Outpatient area and the next day another completely different clinical area.

Staffing Changes

In 1955, a third Almoner, Helen McGlaughlin, was appointed to Royal Adelaide Hospital staff, but attached to the Radiotherapy Department. In the hospitals Annual Report of 1958, during 1955 Helen had a caseload of over 600 interviews, 95 home visits and nine social reports. Her work covered every aspect of the care of a cancer patient. Practical services included the accommodation for country patients during treatment, transport to hospital, financial assistance and after-care and terminal care.

With the appointment of Helen McGlaughlin, there were now five Almoners working in the department. They worked in relative isolation from each other and functioned without the benefits of staff meetings, statistics, peer review or quality assurance. Their main focus was on the support and follow up of outpatients.

When the Senior Almoner (Mrs Patricia Pieterek) left in 1956 after six years at the hospital, a review of her salary occurred. In comparing the salary of the Senior Almoner with the Senior Physiotherapist, the Senior Physiotherapist was thirty pounds per annum above the Senior Almoner.  The Board approved the salary increase.

To cover the shortage of Medical Almoners, Marie Mune was appointed for the position of Social Worker in 1957. She had only completed the two-year Diploma Course and not the extra year for Medical Social Work.  Her commencing salary was 740 pounds per annum.

By 1958, there were seven members of the Almoners Department: Vivien Salter (Senior Almoner), Francis Kay (Chest Clinic Almoner), Helen McGlaughlin (Radiotherapy Almoner) and Central Office Almoners: Miss G Travers, Frances Cashel, Marie Mune and during the year Miss L Seedsman was appointed to make the seventh member of the staff. The Clerical staff comprised of Miss E White, Miss J Finn, Miss J Noble and Miss D Allen.

The Almoner Department was also active in the wider community; as well as giving lectures to university students, also gave lectures to infant welfare trainees at Torrens House on aspects of social work.  Almoners from Royal Adelaide Hospital also served on the Committees of the District and Bush Nursing Service, the Polio Welfare Association, the Paraplegics’ Association, the Curative Committee of the Crippled Children’s Association and the Committee on the Care of the Aged.

For several years, the Royal Adelaide Hospital Almoner Department was involved in setting up and supporting a service at The Queen Elizabeth Hospital. In February 1959, Helen McGlaughlin, Royal Adelaide Hospital Almoner, was appointed Senior Almoner at The Queen Elizabeth Hospital. She resigned at the end of 1960 to marry, and later returned to Royal Adelaide Hospital.

Mental Health

The Almoners Department was starting to notice the increasing demands on their time from mental health patients:

An increasing number of patients is being referred for social help where physical symptoms show no organic disease, but reveal emotional disturbance or anxiety, which is affecting health. In some instances, these people have unhappy homes or other unsatisfactory social relationships. The alleviation of their problems and a better understanding of themselves in relation thereto, helps them make a satisfactory social adjustment.

Royal Adelaide Hospital Annual Report, 1956

In 1964, the Senior Tutor in Psychiatric Social Work at the University of Adelaide, Miss FN MacNamara, was granted Honorary status at the hospital. This was to enable her to access to psychiatric patients. She was granted Honorary Almoner, a position she held for five years.

Several years later, in 1967, the Professor of Mental Health, Mr WA Cramond, recommended that one of the hospital almoners be sent to the United Kingdom for training in Psychiatric Social Work.  However, the Mental Health Services were intending on sending one of its own Social Workers to this course of training. The Board accepted in principle Professor Cramond proposal and resolved to attempt to recruit a trained Psychiatric Social Worker to fill the next Almoner vacancy in the hospital.

Cadetships

There was still difficulties attracting trained Almoners to the hospital. In 1959, the Senior Almoner, Vivien Salter requested that three Cadetships be offered to assist with the difficulties of staffing the Almoner Department. Lack of suitable staff had been an ongoing issue, over a period of many years.  She asked that two Cadetships be for men and one for a woman over twenty-five years of age, under the same conditions offered to the Cadets at the Children’s Welfare and Public Relief Department. It was not until 1961 that two Social Studies Cadets from the University were appointed to the Almoners Department.  One further Cadetship was allocated to the hospital in 1962.

Increasingly the Almoner’s Department was spending more time with paraplegic and spinal injury patients. In 1962, the Senior Almoner, Miss Salter visited the Paraplegic Unit at Fairfield and Alfred Hospital in Melbourne and in 1963 one of the Cadet Almoners, Mr RC Bateman, was sent to Royal Perth Hospital to train under the Almoner of the Shenton Park Annexe.  It was proposed that Mr Bateman will be allotted duties in the Paraplegic Unit following the completion of his training in February 1964.

1960’s

At this stage, there were ten permanent Almoners. There were all trained medical social workers, the majority educated at either the Sydney or Melbourne Institute of Hospital Almoners. On home visits, the Almoners were still required to take the bus or if available, use the hospital’s Morris Minor. However, when this car was disposed of and not replaced in 1963, the staff asked for (and agreed to by the Board) permission to use their private cars on official business or alternatively be provided with taxis.

During the 1960s, the Royal Adelaide Hospital undertook a large redevelopment of the site, with the majority of the old buildings being demolished. At this time, departments were moving locations and when the new Outpatient Block was opened on 27 November 1967, the Almoners Department were ‘temporarily’ accommodated on the first floor.

Name Change

By the early 1960s, the divide between a Social Worker and a Medical Almoner was quickly eroding in Australia and most qualified Social Workers now thought they fitted into a distinct occupational group. “Almoners, the most united group among qualified Social Workers, were now identifying themselves firmly with the whole group … a sign of their identification with all qualified social workers was their use of the term ‘social worker’ rather than ‘almoner’ or even ‘medical social worker’. Australian National University: Professional Social Work in Australia

It was not until 1969, that the Royal Adelaide Hospital gave consideration to changing the the name from Almoner Department to Social Work Department. At this time the Chief Social Worker was Mrs Barbara Garrett (nee Matters), the Honorary Almoner, FM McNamara and Honorary Associate Almoner, M Norton.

Further consideration was given to a proposal that the title of Almoner be changed to that of Social Worker and that a similar alteration be made in regard to the title of the present Almoner service. It was resolved to recommend to the Director-General of Medical Services that the title of Almoner be changed to that of Social Worker, and that the Almoner Service be re-named accordingly.

Royal Adelaide hospital board minutes, 9 June 1969

Lavender Lads & Ladies

In 1971, a volunteer service began at the hospital, initially through the Women’s Inter-Church Council. These volunteers were attached to the Social Work Department and the Church Liaison Officer, Pauline Crosby, had a desk in the Social Work Department. Originally, their object was to assist patients while they were in hospital and in the immediate post-discharge period. These included:

• domiciliary assistance in patients homes for up to two weeks;
• diversional therapy and personal assistance with craft work, books and magazines;
• helping patients in writing letters and simple personal transactions;
• transporting discharge patients to and from outpatients; and
• assisting casualty patients with personal problems such as informing relatives and friends and offering support to relatives waiting for news of patients.

The volunteer service, later renamed the Lavender Lads & Ladies (after the purple uniforms they wore) worked in close association with the hospital’s social workers. Most of the referrals for patient assistance came through the Social Work Department. Gradually as the scope and work increased, the Lavender Lads & Ladies became their own unit, independent of the Social Workers.

When I first came into the hospital I was responsible to the Chief Social Worker, Mrs Barbara Garrett. When Helen Butler and I were appointed official Coordinators we still worked mainly through Social Work, receiving the majority of patients from them. Occasionally we accepted jobs which were authorised by the nursing staff.

Pauline Crosby, Life President of Lavender Lads & Ladies, 1988

1970s

In 1972, the Commonwealth Department of Health introduced the NH5 Form ‘Application for Nursing Home Admission’. This form was completed by persons applying for admission to a nursing home or someone on behalf of the applicant (in the hospitals case, a Social Worker). This increased the workload significantly for the Social Work Department.

The Social Work Director, Barbara Garrett, applied on several occasions for a Social Work Assistant to “act as a co-ordinator of nursing home vacancies and admission requests. Placements being carried out by a central person would cut out duplication of telephone calls, reduce time wastage and create a central contact for hospital staff”. (Internal Memorandum from Barbara Garrett to the Medical Superintendent, February 1973)

By 1976, there were three Social Work Assistants employed at the hospital:

• Mrs Giercaycki specialised in accommodation: providing up-to-date information on nursing homes, private hospitals, boarding homes and rest homes;
• Miss Polydorou was employed as the Equipment Coordinator: maintaining supplies and equipment to patients with chronic disabilities and acting as liaison officer between patients and hospital; and
• Miss Roberts was the Domiciliary Care Liaison Officer: the contact point for Domiciliary Services and the hospital.

The 1970s and into the 80s, again saw an inability to recruit suitable social worker applicants. The workload continued to increase with demand from all sectors of the hospital wanting Social Work assistance. The situation lead to a continuous stream of correspondence between Barbara Garrett and hospital administration:

In the past twelve months this department has operated with vacancies … in an establishment of 19 there have been four vacancies, making a total of 15 social workers to provide a service to all patients of this hospital, including Northfield and Morris Wards. I do not, of course, consider that 19 social workers can, at any time provide the type of service for which an increasing number of clinicians wish. The social workers of this department feel that they cannot continue to cover all clinics in the hospital. Therefore, the present social work service is severely curtailed for those clinics not currently allocated to a social worker. This is done with concern and regret.

Letter from Barbara Garrett, Director Social Work Services to Dr WMJ Sando, Medical Staff Society (Executive Committee)

With the hospital failing to fill the social worker vacancies, the medical staff became involved. Endocrinologist Philip Harding wrote to the Medical Superintendent (September 1975) regarding the resignation of Mrs Calder, Diabetic and Endocrine Unit Social Worker: “It is my understanding that this represents one of two vacancies in the Department of Social Work in this hospital, of which the Public Service Board have been aware for the past six weeks, but which they have not yet advertised … It is unthinkable that the Diabetic Clinic of this size and involvement that ours has should be without a social worker.”

Similarly Visiting Physician HR Gilmore wrote to the Board of Management (June 1974): “For the last three weeks, my Unit has been without a Social Worker. This was due to the transfer of Miss Jane Murrie, who gave us excellent service … inevitably there has been a back-log of cases needing expert assistance of such a person … I am sure the Board will be ready to see that this is an urgent matter, and that it is a very false economy to allow the Social Work Department to run down“

1980’s

At the beginning of 1980, there were several Social Work specific groups and programmes introduced. They included:

• Pre-discharge and post-discharge discussion groups: these were considered essential components in the rehabilitation of coronary heart disease and cardio-thoracic surgery;
• Car accident groups: these regular group meetings targeted young victims of serious vehicle accidents;
• Cancer discussion groups: weekly cancer discussion groups that provided information and support;
• Family Therapy Programmes;
• Interpreter service: the Social Work Department was influential in developing an interpreter service at Royal Adelaide Hospital; and
• In-service staff training courses.

However, due to the continuing problems around staffing issues, the result was a reduction in the services provided.

In 1979 the Social Work Service of this hospital lost one position. In September, 1981, one social worker commenced accouchement leave and we do not have permission to fill that position. A third social worker resigned with her last effective day of duty being 5th February, 1982 and we do not have permission to fill that position … Therefore it is regret that I now have to cut all social work services [to eight units and departments] … This situation will continue until such time as we receive permission to fill a position, or these is an appropriate reduction in beds in this hospital.

Letter from Barbara Garrett to Dr R Britten Jones, Ward R6, 10 February 1982

Staffing issues continued to plague the department, resulting in a major reorganisation of the Social Work Department in 1984. The department was divided into teams. Each team was responsible to one of the three senior staff, increasing accountability and the opportunity for shared learning. Special positions were provided to the Occupational Health Unit and the Geriatric and Rehabilitation Unit, with fifteen Social Workers allocated to cover the Royal Adelaide Hospital and Hampstead Rehabilitation Centre (formally the Northfield Wards). The Department was supported by two Social Work Assistants and four Clerks.

The main Social Work Department was located on Level 5 of the Outpatients Building. Radiotherapy and Oncology Social Work Services were on Level 3 Radiotherapy Outpatients. The Casualty Social Worker was located on Level 3 North Wing and Clinical Social Workers on Level 4 and 5 of the North Wing. The hospital Social Workers were now working solely with inpatients and had little opportunity for community follow up unlike their predecessors.

In 1986, the Social Work Department set up a Staff Counselling and Consultancy Service. This provided all staff with a professional and confidential service: “using proactive counselling programmes, consultations and therapeutic interventions, we can help you to reach your potential and participate fully in your workplace and community“. Eventually this service became independent of the Social Work Department.

1990’s

By 1990, the Social Work Department (now located in the Bice Building, Level 5) had thirty staff consisting of twenty two Social Workers, five Welfare Assistants, two Aboriginal Liaison Officers and two clerical staff. There were also five bilingual staff. The two Aboriginal Liaison Officers worked with the hospital’s Social Workers to provide emotional, social and cultural support to Aboriginal and Torres Strait Islander patients and their families. Later on this service became the Aboriginal and Torres Strait Islander Support Unit, independent of the Social Work Department.

At this time, Royal Adelaide Hospital underwent a hospital-wide restructure, resulting in six functional units. As there were insufficient Social Workers to look after all six units, the Social Work Department was formed into four teams: the General Medical Team, the Cardiac and Surgical Specialty Team, the Cancer Services Team, and the Trauma Team.

The department’s activity extend beyond directly working with patients. The staff provided supervised field education to social work students from Flinders University and SAIT including lecturing and tutoring. Many staff were active in the Australian Association of Social Workers and on committees and community organisations such as Anti-Cancer Foundation, SA Association for Hospice Care and the Paraplegic and Quadriplegic Association of South Australia. The department also maintained close links with Lavender Lads and Ladies.

Going Forward

Since its conception in 1937, the Royal Adelaide Hospital’s Social Work Department purpose had altered significantly. No longer Almoners looking after the ‘deserving poor’, the millennial Social Worker has diversified. Their focus no longer on outpatients and home support but on hospital in-patients. This involved a change from long term support work to short term crisis work, with the Social Work Department ever changing to meet the needs of a busy metropolitan hospital.

Written by Margot Way, CALHN Health Museum

List of Identified Staff from RAH Social Work Department (not complete)

1930 & 1940

• 1937 Mary T Noall (resigned 1940)
• 1940       Janet Payne (resigned 1946)
• 1941       Margaret Mengerson (resigned 1941)
• 1941       Patricia McLeod nee Marcus – Assistant Almoner, Chest Clinic (1941-1942) (1943-1945)
• 1942       Margaret Reed (resigned 1943)
• 1944       MK Kerr, temporary Assistant Almoner (resigned 1944)
• 1945       Eleanor Jacob – Almoner Assistant – General hospital (resigned 1946)
• 1946      Lynley Dohnt – Welfare Officer (resigned 1947 became RAH Home Sister retiring 1948)
• 1946       Miss G Travers – Welfare Officer then Almoner (1957), Senior Social Worker (1973)
• 1947       Margaret Sullivan – Senior Almoner (resigned 1949)
• 1947       Hannah Buckley (resigned 1949)
• 1948       Frances Kay – Assistant Almoner, then Almoner Chest Clinic (still there in 1962)
• 1948       Christine Douglas – Assistant Almoner then Senior Almoner (resigned 13/01/1950)
• 1949       Barbara Garrett (nee Matters) – Assistant Almoner (resigned 1950), Reliving Almoner (1952-1953), Chief Social Worker -Awarded MBE for her services (1969 – retired 1983)

1950

• 1950       Patricia M Pieterek (nee Sandford) – Almoner, Senior Almoner (1955, resigned 1957)
• 1950       Dorothy Pearce (resigning in 1955)
• 1950       Eva Winter – initially relieving Assistant Almoner (resigned 1953)
• 1950      Elizabeth Hicks – Assistant Almoner
• 1952       Mrs Lee Gray – Almoner (resigned 1953)
• 1953       Mrs Pamela Agostini (nee ?Petersen) resigned 1955
• 1953       Helen Heffernan – Almoner
• 1954       Miss T Hayward – Temporary Almoner
• 1955       Pauline Maddigan – Almoner (resigned 1957 to go to Queen Victoria Maternity Hospital)
• 1955       Helen McGlaughlin – Radiotherapy Almoner
• 1955       Francis Cashell – Scholarship student, then Almoner
• 1956       Vivien Salter – Temporary Almoner then Senior Almoner (resigned in 1969)
• 1956      VR Dermott – Social Worker Morris Hospital, then Almoner 1957
• 1957       Miss D Liston – Almoner (still there in 1969)
• 1957       Marie Mune – Social Worker (completed 2 yr diploma not 3 yr medical almoner course)
• 1957       Miss L Seesman
• 1957       Miss E White – Clerical Staff
• 1957       Miss J Finn – Clerical Staff
• 1957       Miss J Noble – Clerical Staff
• 1957       Miss D Allen – Clerical Staff
• 1958       Mrs M Higgins – Almoner Northfield Wards (resigned 1960)
• 1959       Mrs V Briggs – Temporary Welfare Officer
• 1959       M Norton – Honorary Associate Almoner
• 1959       Mrs von Niedermuller – Clerk/Interpreter

1960

• 1960       Kathleen Forward – Almoner Northfield Wards
• 1963       Bateman, RC – Cadet Almoner then Almoner 1964 (still there 1969)
• 1964       FM McNamara – Honorary Almoner
• 1965       Miss H Metcalfe – Almoner
• 1965       Lorna Hurford – Almoner
• 1965       Margaret Newmarch – Temporary Almoner

1970

• 1971       Faye Lush – Social Worker – medical/surgical unit (resigned ?1973)
• 1971       Mrs H Lawton – Social Worker for Nursing Staff
• 1972       Miss H Gillies – Social Worker
• 1973       Mrs HJ Skyes – Senior Social Worker
•                Miss Jane Murrie – medical/surgical unit(replaced Faye Lush) (resigned 1975)
• 1975       Dr RE Mylius – Associate in Social Work
•                Mrs Calder – Diabetic & Endocrine Unit Social Worker (resigned 1975)
•                Di Gilbert – Deputy Director in 1980
•                Mrs J Osborne – Dermatology and Allergy Clinic (resigned 1982)
•                Mrs C Hoskell
•                Mr J Mortul [working 1982] Vascular Surgery,Prosthetics
•                Miss R Hookings [working 1982] Eyes, obesity, Dunn & Gilmore
• 1976       Miss Polydorou – SW equipment Coordinator
• 1976       Miss Roberts – SW Domiciliary Care Liaison Officer
•                Mrs R Dyer – working in 1981
•                Miss Vanessa Swan: working 1982 in Dermatology and Allergy Clinic – replace J Osborne
•                Mrs J Harvey [working 1982] in Profess Develop & Staff & Studen Supervision
•                Mrs J Barritt [working 1982] in plastic & oral surgery, head and neck and burns clinic
•                Ms L Blunden [working 1982] Casualty, ESS Gynae
•                Ms C Davis [working 1982] psychiatry – transfer to hillcrest 1982
•                Mrs D Ervine [working 1982] Spinal and Morris
•                Ms M Janssens [working 1982] Beare/Russell & Haematolgy
•                Mrs J Juttner [working 1982] Butler & Rheumatology
•                Mrs H Lawton [Working 1982] Occupat Health Unit
•                Mr P Schulz [working 1982] Hampstead
•                Mrs L Sellars [working 1982] Oncology, radiotherapy, Harvey, Ward, Wigg
•                Ms L Taylor [working 1982] Cardiac, Thoracic Surgery, Coronory Care, Antic
•                Mrs A Whiting [working 1982] – PMU & Renal
•                Mrs C YPMA [Working 1982} Neurosurgery, ICU, Morris
•                Mrs S McGee [working 1982] Radiotherapy, Dr Ahmad, Dibden, Heitman, Martin House

1980

•          Mrs C Haskell (resigned 1982)
• 1983       Elaine Treagus – Chief Social Worker (resigned in 1997)
• 1983       Maria Harries – Senior Social Work (resigned 1987)
•                Miss Benness – [working in 1982] Orthopaedic Ward Social Worker (resigned 1983)
•                Mrs Sellars – Orthopaedic Ward Social Worker (resigned 1983)
• 1984       Trish Jolly – Deputy Director of Social Work

1990

•        Ruth Walter, Assistant Director of Social Work (working 1990)
• 1997       Trish Jolly – Director of Social Work

2000

• 2000       Carl Phillipson – After hours service
• 2000       Margie Major
• 2000       Mary Hall – Daytiem Trauma Team
• 2000       Tony Carella – Daytime Trauma Team
• 2000       Sue Hansen – Trauma Team Leader

(Information sourced from Trove, History Trust, Ancestry, State Library of South Australia and SA Health Museum collection.  Copies of all newspaper articles and other relevant documents are available on request).