March was World Social Work month….

Leaving No One Behind

Here at St Christopher’s we have nine qualified and experienced social workers who provide support to the most vulnerable and marginalised groups in our community, whether in Sydenham or Bromley, at the hospice or in the community. They support patients, carer’s and families to enhance quality of life and death, affirming, normalising and bringing meaning to the real-life experiences of those they work with.

As March marks World Social Work Month, we wanted to highlight the work of our Social Work team and caught up with two of our social workers to explore how they support patients and families, while working alongside other teams at the hospice and organisations and services in the community. They also explained how their team engages within the theme for World Social Work Month 2022, which is ‘Co-building a New Eco-Social World: Leaving No One Behind’.

Conor Murray joined St Christopher’s Hospice in January after previously working in North London and Vancouver, Canada in different palliative care fields. Marie Berteau qualified as a Social Worker in 2008 and has been at St Christopher’s for more than 3 ½ years.

Day-to-day, what is the work of St Christopher’s Social Work team?

Conor: We asses individual needs from an emotional and psychological standpoint and then their social needs. Getting to know who is in their network, be it friends, family, carers. It’s really important to get an understanding of who the patient is, their coping mechanisms, their values, to inform how the wider hospice team would work with them.  

Marie: We need to work out what they need, it’s the $10M dollar question, so it’s helping them to identify their own needs from a person-centred perspective, empowering them to take the lead on their own assessment. We also do training on the wards with the staff, Mental Capacity Awareness Training, for workers involved in caring for adults who may lack the capacity to make life decisions.

What kind of patients do you work with?

Conor: It’s very varied, we’ve got people who’ve just been referred to us but others who are coming to the end of their life. With some people we do life review work. With one young patient we talked about achievements, milestones, things that really stuck out for them. It gave them a lot of comfort as it gives them the chance to reflect on their life. It’s not for everyone, but for this individual it provided them a space to reflect. When else are you going to get a chance to sit and reflect on your life? It can be really therapeutic.

In psychosocial palliative care, we see the family as the unit of care. We provide space for patients to talk about worries they may have about their children and how they are coping with having a parent living with a life limiting illness. Social Workers have the training and skills to advise patients and carers in preparing for sensitive conversations with their children about death and dying.

How do you engage with the theme of ‘No One Left Behind’?

Conor: Our fabric really is about social change and standing up for equality. For example, I know that Michele King (Team Lead – Social Work, Welfare, CBT & Art and Music Therapy) did some work around using appropriate language when talking about patients. It’s about really making sure that we are inclusive. Using appropriate pronouns, not using labels, for example.

As Social Workers we are agents of change and we stand up for social justice. We often work with the most marginalised clients that we see in the hospice. They’re people living with severe mental illness, substance use, homelessness, immigration concerns so we are the voice of advocacy.

What does that look like when perhaps that individual wants to be left behind, or is rejecting our support?

Conor: We work from a standpoint of person-centred care, we affirm their views about their health and believe in self-determination. We have a patient who’s refusing opioid-based medications and they’re refusing any treatments being offered because they don’t believe they’ll work. There’s a lot of moral distress from medical professionals and even from myself, I don’t necessarily agree with the patient’s views, but I 100% affirm them. We all come from different backgrounds with different experiences that shape our decisions and our role is to just listen.

Marie: I went to see someone and it was difficult to engage; they didn’t want us to help. I said ‘That’s fine, but what have we done wrong?’ And he thought we were a ‘death camp – people come here and never return’. Of course, this is not the case; the understanding of palliative care was completely zero. I broke it down, explained our care and they were reassured. So, we need to try and engage with the patient because there is a lot of stigma around hospices and palliative care.

Conor: It’s about explaining what palliative care means, because when people are referred to us I don’t think it’s fully explained. When we meet people for the first time they could have a lot of fears and anxieties whereas, when they actually come and see what we do it’s relaxed, we’ve got music on, it’s comfortable.

How do you work with your clinical colleagues on the ward and in the community?

Conor: We educate our medical colleagues, so we’ll do case consultations, they will give us a call If they have questions around somebody who might be struggling to adjust to their situation.

Marie: We hold Multi-Disciplinary Meetings where they would present a case, where there is a social work need or they are stuck in how to manage the situation, we’ll say, let’s try that and that. We’ll then do a joint visit with the doctor or nurse and support them.

Conor:  We also work in collaboration with other professionals and community partners. Last week I had a meeting because a patient was under St Christopher’s but their partner was under the community mental health team. So, we had a meeting with their team to make sure we could come up with a plan to support our patient but also the carer, who happens to be living with serious mental illness.

You cover a large part of London which is really diverse, how do you engage with communities which are perhaps harder to reach?

Conor: We have to be informed around culture and what palliative care means e.g. in some languages and cultures, there is no direct translation for the term ‘hospice’ and talking about death and dying can often be quite taboo. Therefore it’s really important to respect cultural backgrounds and be informed on what death means and how to approach sensitive conversations.

Marie: It can be a really fine line in when to push and when to pull but to provide an explanation.

What is one crucial lesson you have taken from your time in social work and palliative care?

Conor:  Personally, working as a social worker in palliative care, not to get upset about things that are quite trivial in life. Professionally, the importance of advocacy and advocating for a client in a system which often has different perspectives. Because I think sometimes we have to be, we have to constantly remind that person-centred care is so important that we have to work from that point of view, as opposed to what we think is the right point of view because patients might decide to do things that I might not agree with! But through reflective practice we get to a point where you respect self-determination.

Marie: I think the value of Advanced Care Planning — I’ve even done that for myself! I took my husband and my sons to the local crematorium and said ‘This is where I’m going to be. I want this tree.’ The same for my parents, every time I go to visit them in France I ask them ‘How is it going with your funeral plan?’ I think being open about death but of course there’s a fine line and I think I find that hard when I’m not in the hospice and it’s about switching off. I have to forget about palliative care sometimes, and not start talking about death and dying in the middle of a party. So, I’ve learnt to take a little bit of a step back outside of work.