“I didn’t think you were here today – your broomstick isn’t in the car park!” One of the friendlier greetings received in a past existence as a child protection social worker. Social workers in child protection have to become personally tough as well as professionally rigorous. At the same time they need to remain sensitive to the present pain and tragic histories that fuel the hostility they sometimes face as representatives of authority.
Social workers in palliative care need similar qualities and skills, albeit for rather different purposes. Like their colleagues in other specialisms they need to know and be able to interpret complex and contentious areas of law and policy; as well as having an up to date understanding of the rapidly moving landscape of benefit entitlements. Palliative care social workers act as tough and determined advocates for service users. They provide expert advice to nursing and medical colleagues often around concerns relating to safeguarding, deprivation of liberties, and capacity/best interests decisions. They are often called upon by the wider team to intervene where there are conflicts within families or their social networks or to work with children.
Like their colleagues in other areas social workers in palliative care work within tight time boundaries – not the arbitrary timescales of rules and regulations but the non-negotiable ones of life and death. On a daily basis palliative care social workers use hard edged legal knowledge and skills of informal and formal advocacy to support palliative care patients and their families to cut through bureaucracy and secure the care, payments or other resources that allow them to exercise the kind of choices that matter most at the end of life. This might be the choice to die at home or in a nursing home that is close enough for family and friends to visit freely rather than in a hospital ward.
Equally important within the palliative care social work role are the softer qualities and skills needed to provide compassion, counselling and spiritual care to patients and family members.
Social workers in palliative care appreciate the opportunity that this area of specialism provides to work closely with other members of an expert multi-professional team. The core values and outlook of social work are particularly well aligned with those of palliative care, which is above all holistic and person centred. Social workers can offer a more in depth and practical understanding of how patients’ other roles, as for example parents, siblings, partners, home makers, breadwinners, colleagues and friends, affect their experience of and reactions to their illnesses and the treatments they are offered.
Social workers themselves play an important role in helping patients and families to maintain these important parts of their identities; while at the same time preparing for the future. They support service users and their families and carers to have a voice and play an active part in shaping their own care and services. Research undertaken by Beresford et al (2007) showed that service users (both patients and family members) valued this highly and at the same time appreciated the ‘ordinariness’ of their interaction with social workers. They described how social workers came to talk to them in places that were familiar and comfortable and spoke in everyday language.
This orientation towards working with people not just as individuals who are terminally ill, or defined by their roles as ‘carers’ or ‘the bereaved’ but as integral members of families, communities, and work places means that social workers in palliative care are well placed to contribute to the new directions that are emerging within palliative care services. One example is a project led by a social worker from St Mary’s Hospice in Birmingham, which set out to develop closer links with members of the local African-Caribbean community, yielding the lesson that is well appreciated by many social workers, that often we learn at least as much from those we set out to help as we have to offer them in return.
The National End of Life Care Programme’s Framework for Social Care (2010) highlights the potential of palliative social workers to act as teachers and mentors and to provide leadership for colleagues in other social care roles; as a means of improving their knowledge, skills and confidence in working with people approaching the end of their lives. Projects funded through this programme in London and Gloucestershireprovided practical demonstrations of how this has can contribute to improving practice in local authority services.
Specialist palliative care social workers represent a very small group within the profession as a whole but punch well above their weight – measured in terms of contributions to national and international working groups, research and publications.
Palliative care social workers in the UK have their own professional organisation, the Association of Palliative Care Social Workers. Its 250 members are all practising social workers and all its officers are volunteers. The association provides advice, support, regional meetings and a national conference each year. It has a newsletter, website, Facebook page and presence on Twitter. It is linked to the European Association for Palliative Care and one of its members is currently leading a European Taskforce on the future of palliative care social work.
The association has a proud tradition as a champion for service users. Members campaigned for the introduction of the ‘Special Rules’ that enable people who are terminally ill to gain rapid access to the higher rates of Disability Living Allowance and Attendance Allowance. Its latest report on service user involvement will be out soon.
Celebrating the memory of a distinguished colleague and looking forward to the next generation the association will shortly call for entries for the Frances Sheldon Award for a Master’s dissertation relating to palliative care social work. Please watch this space – but don’t expect to see any broomsticks!
Beresford P, Adshead L, Croft S. (2007) Palliative Care, Social Work and Service Users
NEoLP (2010), Supporting People to Live and Die Well
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