Recent debates about the professional representation of social work in England have centred on the respective roles, credibility and effectiveness of the British Association of Social Workers and The College of Social Work. But practitioners in palliative care have been relatively shielded from these by the longstanding presence of a specialist body to represent them: the Association of Palliative Care Social Workers.
Its 250 members are drawn from hospices, council community teams and hospitals, and its role extends from supporting members in their roles to campaigning on policy and working to spread good practice in the delivery of end-of-life social care.
With no paid staff, it relies on the time and goodwill invested in its work by its volunteer officers, now headed by chairperson Anne Cullen, manager of psychosocial and spiritual care at Princess Alice Hospice in Esher, Surrey.
Cullen, who qualified in social work 30 years ago, came to palliative care relatively late following a career that took in working in generic and then children and families practice, during which time she rose to the position of service manager. She also previously worked for Skills for Care.
Cullen has set four priorities for her leadership of the association, and at the top of this list is developing links with other parts of social work and social care.
Palliative care social work, particularly in hospices, is strongly linked in with the medical and therapeutic professionals who also work in those settings.
“But we also need to look out to mainstream social work and be part of that conversation as well,” she says. Cullen believes the time is ripe for such a development, with an increasing focus on social workers being freed from bureaucratic shackles to exercise their professional judgement, in both statutory children’s and adults’ services. This chimes with the approach taken in palliative care, which she sees as “a model of social work that’s very much in keeping with the direction in which people want the profession to develop”.
Building emotional resilience
A related ambition for her leadership is to raise the profile of palliative care social work among the rest of the profession and share learning, including in areas such as building emotional resilience among practitioners.
In her day job, Cullen leads on the delivery of Schwartz Centre Rounds, regular meetings that enable professionals to come together to reflect on their practice, including its stresses and strains. Research by the King’s Fund has found that participants felt that the rounds improved the quality of patient care, strengthened team work and improved culture. Such an approach is well developed in hospitals and hospices in the UK but less so in social services departments.
“In other areas of social work there are some emotional challenges and dilemmas and the opportunity to develop healthy organisations is very important,” says Cullen. “So if we can bring these types of experiences to bear that may be a contribution that we can make [to mainstream social work].”
The association is also seeking to spread learning in relation to end-of-life care among practitioners working in statutory adults’ services, through a series of workshops it will be running this year. This builds on projects commissioned by the former National End of Life Care Programme to develop the quality of social care and social work at the end of life.
Cullen also wants to improve support for her members, particularly those working as the sole social worker in their setting, for whom peer support may be lacking.
Her fourth priority is developing service user involvement in palliative care. A report last year for the association, based on a survey of social workers, found most user involvement consisted of consultation over services, with little in relation to planning, evaluating or auditing services, or in education and research.
Free social care
The association will also be keeping tabs on policy developments, particularly in relation to welfare reform – benefits advice for families being a key plank of palliative care practice – and the possible introduction of free social care at the end of life.
The measure was proposed by the government-commissioned Palliative Care Funding Review, as a way of removing funding barriers to people being cared for at home, rather than hospital, at the end of life. On the review’s recommendation, the government is testing its proposed funding model in eight pilots that conclude in March.
Care minister Norman Lamb said last month he was determined to introduce free care but could not commit the government to it until the evaluation of the pilots had reported. Cullen and the association strongly support free care, as do the leading charities involved in palliative care, such as Macmillan Cancer Support, Marie Curie Cancer Care and Sue Ryder.
“It’s very difficult to deliver good quality palliative care at home at the moment,” she says. “Providing personal care to those who need it would make a massive difference to people’s ability to achieve the experience that we would all want for people at the end of life.”
It all makes for a big agenda for a volunteer-run organisation.
“We are a small organisation and all of the work of the association is done in people’s spare time,” says Cullen. “It’s difficult to do as much as we would like but I think we are quite effective.”