Social work is an integral part of the multi-disciplinary team within palliative care, offering an holistic service to patients and families. Unlike many fields of social work, specialist palliative care social work is potentially a universal service and we are used to working with a diverse range of people in terms of age, diagnosis, class, ethnicity, sexual orientation, religion and culture. Palliative care social work involves working with two groups of people – direct service users with life threatening or terminal conditions and those who are bereaved. Social workers are skilled at balancing the different and sometimes competing needs of the two groups.
Specialist palliative care social work is provided in a range of settings, including independent hospice, day hospices, NHS specialist palliative care units, oncology wards and in home care teams. It includes working with people with cancer, HIV/AIDS, Motor Neurone Disease, chronic circulatory diseases and other life threatening illnesses. Specialist palliative care social workers are used to working across the fields of health and social care and often provide a link between the two. They are used to working with both children and adults and in working with people in their own homes.
Specialist palliative care social workers offer a wide range of support to patients and families from practical help and advice around income maintenance, debt counselling, help with housing and accessing other services, through to advocacy, individual counselling and group support. This will include bereavement work with adults and children both as individuals and in group settings. Key to specialist palliative care social work is the desire and ability to see people as whole people and not as set of problems, to understand the connections of their lives and to seek to act, rather than ignore the constraints and discrimination they experience in society. As Napier has observed, “social work places ideas about crisis, loss, grief and bereavement within an appreciation of people’s diverse and unequal social circumstances” (Palliative Care Social Work, Lindsey Napier in Patient Participation in Palliative Care, A Voice for the Voiceless, ed Barbara Monroe and David Oliviere OUP, 2003)
Because we tend to work with patients within their social context we are able to see advocate for the patient within their family and community, be sensitive to their cultural and spiritual needs and to advocate for practical support and services on their behalf. Additionally specialist palliative care social workers are usually skilled in counselling and family work. The combination of skills offered by specialist palliative care social workers makes a unique contribution to the psychological and social aspects of the multi-disciplinary professional team caring for patients, their families and cares.
Provision of palliative care is patchy and not uniform or consistent across the UK and some palliative care services do not employ the services of a social worker. Research has shown just how much service users value the help and support of palliative care social workers. A research project carried out at the Centre of Citizen Participation, Brunel University, funded by the Joseph Rowntree Foundation showed that specialist palliative care social work had played an absolutely crucial role in the way that service users had coped with illness, impending death and bereavement. (The Involve Project, What Service Users want from Specialist Palliative Care Social Work).
Another significant finding of the Involve Project is that it was often not clear within a hospice or specialist palliative care service at what point a service user would be referred to the social worker. There was evidence of inconsistency even amongst service users accessing the same social worker. It was clear that other professionals often played a gate keeping role. Yet many service users said they wished they could have seen a social worker earlier on in the progress of their illness, even for some at the point of diagnosis.
A serious concern facing the Association is that, within budget restraints, some specialist palliative care services and hospices may choose to cut the services of the specialist palliative care social worker. This deprives patients, families and carers of a vital source of support, which can not be provided by other members of the multi-disciplinary team, and which is invariably not available in the community. There are significant differences between the often managerial role of the care manager, working within the community, and that of the specialist palliative care social worker who will be providing a wide range of support to vulnerable patients and their families.
We feel it is extremely important, as an Association, that we continue to flag up and highlight the role of the Specialist Palliative Care Social Worker and seek to make sure that social workers are always seen as a crucial part of the multi-disciplinary team within palliative care. We have also produced standards for specialist palliative care social work, which we hope will inform and enable those setting up or working in a specialist palliative care social work role.
Suzy Croft
