A dying need

It sounds too good to be true: a social care job with minimal
paperwork and the chance to practise in a traditional therapeutic
style. The good news is that the job does exist, but those who do
it must deal exclusively with service users in the final stages of
life and will be pursuing a career with few opportunities for
promotion.

The job, palliative care social worker, offers physical,
psychological, social, spiritual and financial support to people
with cancer, heart or kidney failure, multiple sclerosis, motor
neurone disease or Aids.

But to underline how small this branch of social work is, the
Association of Specialist Palliative Care Social Workers has just
240 members – so the number of jobs are few and training and career
structures limited.

Whether it is because palliative social work is seen as a bad
career move, unglamorous or depressing, recruitment is difficult.
The jobs that are available need experienced social workers who are
willing to work alone or as part of small social work teams in
health settings, says Ann Quinn, director of social work and
lecturer in palliative care at Reading University.

Lone working leads to a lack of conventional social work career
paths, adds Quinn, who also points to a shortage of structured
training for palliative care social workers. Many have
qualifications in counselling or family therapy but there aren’t
many courses specifically on palliative care social work (see
“Options for study”, below).

Pat Menzies, palliative care social worker at St Ann’s Hospice in
Manchester (see “Emotional connections are key”, bottom of page),
agrees that the career structure in her sector is “fairly flat”,
although, for her, job satisfaction is more important than
progressing up the ladder.

Despite government rhetoric about integrating social and health
care, a report last year on palliative care by the House of Commons
health select committee found too many patients falling into the
gap between the two services and that too many were dying at home
“in squalor” because of lack of social care support. Perhaps in an
attempt to address this, the government has pledged to double
spending on palliative care for people with cancer. Details will
be  set out in the forthcoming joint health and social care white
paper.

In the meantime, palliative care social work, like many other areas
of social care,  suffers from playing second fiddle to health.
Within palliative care teams, medical care is the top priority.
National Institute for Clinical Excellence (Nice) guidelines list
the staff required for specialist multi-disciplinary palliative
care teams.(1) Essential team members are listed as consultants,
nurses and an administrator. Then, in the following order, the
guidelines say a further range of experience can be provided by:
physiotherapists, occupational therapists, dieticians, pharmacists,
social workers, and chaplains or spiritual caregivers.

Anne O’Callaghan, a specialist social worker in palliative care at
Darent Valley Hospital, Kent, for the Macmillan Cancer Relief
charity, also works in the local community and agrees that NHS
staff often pay token respect to social workers and their views are
not always sought. But she is unfazed by this as she is experienced
in dealing with health colleagues and has the confidence to
challenge their views.

But by working with health professionals, palliative care social
workers are often lone non-medical members within teams. So,
although their work is valued by service users, it is often
marginalised by health professionals and even by fellow social
workers, says Suzy Croft, palliative care social worker at St
John’s Hospice in London and chair of the Association of Hospice
and Specialist Palliative Care Social Workers.

Croft, a palliative care social worker for 16 years, 12 of them at
St John’s, believes the role is unsuitable for newly qualified
social workers. She recommends at least five years’ social work
experience before moving into palliative work as any branch of the
profession will provide useful skills. “You need to understand that
death is part of life, normal, happens to all of us,” she
says.

O’Callaghan has spent most of her social work career in palliative
care, mainly in the voluntary sector and the NHS, apart from two
years as care manager for older people at the London Borough of
Greenwich.

She estimates that three-quarters of her week involves dealing with
service users. Paperwork is manageable.

“I am very involved with the vulnerable people and their families I
work with. I can offer total care. I don’t want to sit in an office
all day, that’s not for me,” says O’Callaghan. “I listen. My
patients believe I have all the time in the world.”

The assistance required varies. “Some patients want me to find
someone to look after their cat. Others ask me to tell their family
about a diagnosis if they can’t face it. Or I will help with money
or accommodation problems, or try to track down estranged children
to break the news.”

O’Callaghan has found it difficult working with some religious
single African mothers, who believe God will not allow them to die.
Consequently, the women will not discuss future arrangements for
their children. O’Callaghan worked with one mother who had three
children in Nigeria and two in England. The mother died, with no
provision made for her children, and their fathers were not around.
The children in England were taken in by a family friend, but the
arrangement broke down after three weeks.

Palliative care allows social workers to use more of their skills
more often. They spend more time with clients and less time on
bureaucracy, so fulfilling the reason why they chose to go into
social work in the first place. Perhaps it’s a career move that
more social workers should consider.

(1) National Institute for Clinical Excellence, guidance
for England and Wales, Improving Supportive and Palliative Care
for Adults with Cancer, 2004. From
www.nice.org.uk/page.aspx?o=110005

Options for study

Most palliative care social work posts are in hospices, the rest
are local authority or NHS jobs, based in hospitals and the
community.

There are no post-qualifying courses in palliative care in the
General Social Care Council’s framework. The council says courses
in adult specialisms are still being discussed, and palliative care
could be included.

Other options for further study include an MSc in psychosocial
palliative care at Southampton University; a palliative care MSc or
diploma at Oxford Brookes University; and an MA or diploma in the
ethics of palliative care at Keele University. St Christopher’s
Hospice in London runs courses, including a postgraduate
certificate in childhood bereavement, validated by Middlesex
University.

The social work degree syllabus does not include any compulsory
modules on palliative care, but optional courses are a
possibility.

‘Emotional connections are key’

“Finding the right words to describe my job is difficult”, says
Pat Menzies, palliative care social worker at St Ann’s Hospice in
Manchester. “I make emotional connections with people who are
dying.”

In western culture, says Menzies, we pretend we will be here for
ever. She believes that to work successfully with people who are
dying, you must first face your own death, which takes
courage.

St Ann’s is the UK’s largest hospice and staff care for about 3,000
people a year at three sites in Greater Manchester. St Ann’s is
second in the 2005 Sunday Times list of 100 best companies to work
for.

The job involves offering practical and emotional support. Benefits
advice and bereavement counselling are also important duties.
Menzies finds her job rewarding and challenging and she instantly
felt she had found the right post when she saw the advert because
it seemed to be the “culmination of all my experience and
training”.

She had previously worked with older people and with young disabled
people at local authorities in north west England, and has a
counselling qualification.
The ability to listen is a crucial skill in the job, says Menzies.
Time spent with service users is varied and unpredictable but is a
large part of the job. Working with the whole family is
vital.

“Sometimes I am with patients all day but that’s not always the
case. Developing services and feeding into policy-making are
important. Admin is less intrusive than in other social work roles,
such as care management.

“My job is to find out what service users want and to make it
happen.”

‘I am comfortable with death’

“In my job I can spend the whole afternoon with a service user
and no one will ask where I’ve been. We get the chance to work
in-depth with dying people and their families,” says Briony Farr,
head of social work at St Gemma’s Hospice in Leeds.

Farr calls her job title “rather grand”, as her role is essentially
a practitioner’s. She has a 20-year career in local authority
social work under her belt, in hospitals and in the community, as a
practitioner and manager, mainly working with older people.

Farr’s background sparked her interest in the job at St Gemma’s and
she joined in 2004. The hospice has 32 beds in two wards. “I like
the hands-on practice and working in a small environment,” she
says.

Farr is part-time, working 32 hours a week. Her team includes one
other part-time social worker (22.5 hours) and a bereavement
service co-ordinator (24 hours).

She feels an equal partner in the hospice’s multi-disciplinary
team. “We look at the patient’s needs together and share files,”
she says. “Genuine joint working is a hospice ethos. The social
work team is not a junior partner to health colleagues.

“I enjoy my job very much. It’s stimulating and challenging but
hard emotionally.

“The hospice is a supportive atmosphere and I get good supervision
from a psychotherapist. I am comfortable with death. But your
beliefs get shaken in this job.

“When someone you love dies, it is the major crisis in your life.
There’s no getting away from that fact. Any tension is to the fore
and families are often in acute distress. My role is to take the
heat out of situations. Families can offload on to me.”