Social workers taking part in specialist end-of-life care training are gaining new skills and more confidence, writes Maria Ahmed
● Project name: End-of-life intervention skills consultation and education pilot in Lambeth and Southwark.
● Aims and objectives: To improve end-of-life skills, training and support for adult social care workers, with particular emphasis on earlier end-of-life planning and holistic understanding of well-being.
● Number of staff delivering project: 2.
● Number of staff trained: 167.
● Cost: £27,000.
● Outcomes: Managers were able to identify end-of-life care training needs for adult social care staff. The majority of staff underwent basic awareness training and end-of-life training was included in team work plans; evaluations showed high levels of satisfaction with training.
“The issue of end of life fills you with dread,” says Myrtle Bernard, head of community disability and older people’s services at Lambeth Council, south London. “Naturally, we don’t want to contemplate what it means, so engaging in these conversations can be uncomfortable.”
Addressing social workers’ fear of cases involving people nearing death was a key objective of a project to improve practitioners’ skills in palliative care, involving Lambeth and neighbouring Southwark Council.
The project, led by St Christopher’s Hospice in south London, was among six funded by the National End of Life Care programme to improve the response of adult social care staff to people nearing the end of life.
Unlike health professionals, social workers have little specialist training in dealing with end-of-life scenarios, Bernard suggests.
Practitioners commonly find themselves planning at crisis point when service users express a wish to leave hospital and die at home. As a result, they have no time to prepare for the end, she says.
Bernard believes practitioners need to develop more skills and confidence in palliative care planning.
“We need to put end-of-life care on the training map, but social work is just beginning the journey,” she says.
Andrea Dechamps, director of social work, bereavement and welfare at St Christopher’s, says the pilot led to a “real culture shift” in the two boroughs.
“We receive consistent feedback that day-to-day practice is already changing,” she says.
Dechamps led a team of two St Christopher’s staff in delivering the pilot between October 2010 and April this year.
Advice for colleagues
One of the key outcomes was the appointment of end-of-life “care champions” in each participating borough – practitioners tasked with keeping abreast of developments in palliative care and advising their colleagues.
As part of the training, staff discussed their feelings about death as well as gaining practical skills in recognising the signs of dying, integrating spirituality and advance care planning.
Practitioners were able to identify problems in the way they assessed service users, St Christopher’s trainer Lesley Adshead says.
“Staff avoided raising emotional issues – their forms could become ‘hiding places’ that perpetuated this avoidance. We encouraged them to take the risk,” she says.
Since the pilot ended, Southwark and Lambeth have been reviewing assessments and work shadowing has been arranged for a Southwark social worker with a St Christopher’s practitioner.
Michelle Stanfield, Southwark’s duty discharge manager at King’s Hospital in south London, says: “There is now more evidence within social work assessments that end-of-life conversations are taking place with service users and their families.”
End-of-life care has moved up the borough’s agenda, says head of older people’s services Ray Boyce. “This is a specialist older people’s service and end-of-life care wasn’t always discussed within assessments. Now it is a topic that is seen by practitioners as important within all aspects of our work.”
Bernard at Lambeth has seen a change in social workers’ previous view of palliative care as a health rather than social care issue.
“The training helped staff to have a better understanding of the terminology of palliative care so they are more confident in dealing with health professionals. They are also spending more time preparing service users for emergencies,” she says.
All those involved in the pilot, which was supported by Guy’s and St Thomas’ Charity, aim to become an example of national and international practice.
Framework for social care
Tes Smith, social care lead at the National End of Life Care Programme, says similar initiatives are underway across the country. The programme produced a framework for social care last year, which called for a network of social care end-of-life care champions to be set up and the role of palliative care social workers in hospices to be strengthened to help spread good practice.
“The changes link well with the personalisation agenda,” she says, adding that they can be sustained if end-of-life care is “prioritised” in staff development.
Boyce is “passionate” about ensuring practitioners have further opportunities and has committed part of his training budget to end-of-life skills.
“This takes us back to core social work values and skills. Social workers within our services now feel more skilled and confident about having difficult conversations with older people who are often vulnerable and frightened,” he says.
End-of-life care champions
Last month, a social worker from Southwark’s hospital discharge team met a service user called Winnie* to review her placement. As part of the review, Winnie, who was living in a local nursing home, was asked about her plans for the end of her life. She wanted her next of kin to be with her at the time of her death and for her ashes to be scattered in the sea. Winnie’s daughter and the nursing home manager were also involved in the discussion. Recently, the discharge team received the news that Winnie had passed away and that her plans had been carried out.
For Mary Tagoe (pictured with Grace Fordham), one of Southwark’s end-of-life champions, such cases illustrate how social workers’ approach to palliative care has changed in the borough, following training delivered by St Christopher’s Hospice.
Tagoe, a social worker at Southwark’s adult’s community based team, believes practitioners were not as confident in planning for the death of a service user before the training. “Many of us felt uncomfortable about talking about end of life issues and it was a subject that many practitioners avoided,” she says.
Now, social workers are having conversations about the end of life and can draw on Tagoe’s advice and support when making care plans.
Tagoe has embraced her role with enthusiasm and become a passionate advocate for better end-of-life care. “We need to make it possible for people to die in their own home or a nursing home rather than hospital if that is what they wish,” she says.
Like the other end-of-life care champions in Southwark and Lambeth, Tagoe keeps up to date with end-of-life care policy and practice and is able to share knowledge of local systems. She is also encouraged to research areas of interest to her team and present her findings.
Tagoe says the training has led to an overall improvement in the quality of service, not only for service users but their families. “Relatives benefit when end-of-life plans are made sensitively according to their loved-ones’ wishes,” she adds.
Tagoe, who qualified in 2007, believes end-of-life care should be included as part of the core curriculum on social work courses. “When I trained, the course covered loss and bereavement but we did not explore in any depth how to work with people around preparing for end of life,” she says.
*Not her real name
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