Did anyone hold your hand as you learned the trade of palliative care? - David Oliviere

A tribute to Elisabeth Earnshaw-Smith, pioneer of palliative care social work and psycho-social palliative care, and first Director of Social Work at St Christopher’s Hospice, who died in January 2023, at the age of 93 years. David Oliviere pays tribute to an extraordinary life – and her very modern vision of positioning dying ‘as a family, social, community experience’.

‘…time for endings, time for last words, for caresses, for getting a family together and for just being with a family.’ Elisabeth Earnshaw-Smith (1).

All of us have been inspired by someone in our developing career: a colleague; a mentor; a role model; an inspirational teacher who has trodden the path before us; someone who unconditionally shared their knowledge, tips, skills and stories in hospice and palliative care (2). Someone who took that extra time or made you feel you could do it!

Elisabeth Earnshaw-Smith, first director of social work at St Christopher’s from the 1970’s, was all of these to me, and to so many entering hospice and palliative care in that pioneering era.

In the last interview she gave, Elisabeth recounted that when she saw the post of social worker advertised at the developing St Christopher’s, as an experienced medical social worker, she contacted Dame Cicely Saunders to enquire about the post, which was being offered at a very basic level (3).

Elisabeth was concerned that this new post should be at a senior level, sufficient enough to be able to demonstrate and teach good family care at the end of life and recognise a family’s potential for change, negotiate with senior colleagues in the multi-professional team, and offer skilled practice in family dynamics. A mark of her professional confidence and persistence, Elisabeth was offered the job and the post was regraded!

As multi-professional teams developed in these very early days of palliative care, the biggest number of referrals to the growing social work team at St Christopher’s was for family issues, concerns over children and communication before the death and in bereavement.

One of Elisabeth’s achievements was appointing a competent social work team, including Dame Barbara Monroe who soon became an outstanding innovator, practitioner and thought-leader in palliative care internationally, and subsequently chief executive of St Christopher’s. Elisabeth also helped initiate the United Kingdom’s National Association of Hospice and Palliative Care Social Workers, the first of its kind worldwide.

Another area of work that emerged was recognising the impact that families, death and bereavement can have on staff and engaging colleagues in conversations on the effect of the work on them personally and professionally. Elisabeth recalls how looking after people with Motor Neurone Disease was particularly challenging and ended the ‘honeymoon period’ for many nurses working with dying patients. It was often a turning point when nurses recognised they needed support. Certainly, Elisabeth was a pioneer of modern ‘self-care’.

One of Elisabeth’s greatest achievements as one of the early pioneers of psycho-social palliative care was to challenge the traditional medical models of the era. Instead, the hospice movement and the developing palliative care specialty saw the patient as a human being experiencing a normal life event and dying as a family, social and community experience.

She, together with colleagues at St Christopher’s, developed a model of family care and a family-oriented service, away from one-to-one models with just clinician to patient/ family member communication. Elisabeth pioneered the concept of ‘family trees’ (a pictorial display of a person’s family and other significant relationships) as an assessment and therapeutic tool, as a:

‘way of helping a family to see visually that they belonged together … what a powerful effect this visual demonstration had on patients in helping them get together and communicate … belonging [is] a very important thing to all of us as human beings’ (4).

When I was a new social worker entering the field of palliative care and working at the North London Hospice, one of the first things Elisabeth said to me was‘it’s all about finding people’s strengths and resources’ (4). This mantra has continued to underpin the essential nature of social work in working not only with risk but with resilience and in supporting strengths-based approaches.

Psycho-social-spiritual care works in partnership with patients and family caregivers to name areas of concern in their lives and to be helped in identifying external resources but also to discover internal resources in themselves, in their networks and via local neighbourhoods and communities.

Palliative and hospice care, are almost unrecognisable now compared to where it started from, and this is in great part due to some pioneering innovators (5). But while the context has changed, Elisabeth’s work underlines that death, dying and bereavement are relational experiences and that we need to facilitate stories and narratives that family and friends can go on living with (3). This is a very modern message, with its roots going back to the very beginning of the hospice movement.

References

1. Clark D et al (2005) A little bit of heaven for the few? An oral history of the modern hospice movement in the United Kingdom. Lancaster: Observatory Publications

2. Earnshaw-Smith E (1981) Dealing with dying patients and their relatives. BMJ 30 May:282,1779

3. Oliviere D (2014) Preface. Social work – a relational process. In Wasner M & Pankofer S (eds.) Soziale Arbeit in Palliative Care: Ein Handbuch für Studium und Praxis. Kohlhammer: Stuttgart, Germany

4. Oliviere D (2018) Elisabeth Earnshaw-Smith – discovering people’s strengths and resources at the end of life. EJPC 25(1):16-18

5. Saunders C (2001) Social work and palliative care – the early history. British Journal of Social Work 31: 791-799

Links and resources

Read more about Elisabeth’s life and work on the EAPC blog here.
Learn more about the Association of Palliative Care Social Workers, the organisation which Elisabeth and others established here.

About the author

David Oliviere is a Social worker, Counsellor, Educationalist and is a Visiting Professor for Middlesex University. He is the former Director of Education and Training at St.Christopher’s Hospice, 2001 – 2013 where he was privileged to work with Cicely Saunders.

SAVE THE DATE! EAPC 18th World Congress 15-17th June 2023. Find out more here.