Social workers should be co-ordinators of end-of-life care, says report

Social workers should be tasked with joining up end-of-life care to help end “unacceptable inequalities” in the provision of support to those who are dying, says research out today.

The study by think-tank Demos said social workers should take on the role of care co-ordinator as part of multi-disciplinary services based on the community mental health team (CMHT) model.

The study, based on analyses of clients’ journeys through services at the end of life and consultation with experts, practitioners and patients, found that individuals’ different starting points determined outcomes, resulting in significant inequalities.

Significant inequalities

Compared with others, cancer patients received earlier and better diagnoses, better follow-up support and dedicated help to ensure their end-of-life wishes were carried out; though accounting for 27% of deaths, they accounted for 90% of hospice patients. 

By contrast, those with multiple conditions were likely to receive delayed and disjointed care from the many agencies they were in contact with. People who used social care before their end-of-life needs were identified were also more likely to stay within the social care system thereafter and lacked access to specialist health services and hospice care. Those with dementia were also far more likely to be hospitalised prior to death or to die in hospital than other groups because of a lack of community support.

The report, supported by care provider Sue Ryder Care, said integrating health and social care for people nearing death, and ensuring their support was co-ordinated by a lead professional, was key to improving outcomes for disadvantaged groups.

Social workers should be care co-ordinators

It backed the creation of integrated end-of-life care teams – based on the CMHT model – with service users given a care co-ordinator to help them navigate the system and ensure their end-of-life wishes and needs were met.

While for cancer patients, this role was often carried out by Macmillan nurses, the report called for care co-ordination to be made available to other service users; experts interviewed for the study said social workers would be particularly suitable for the role.

“Taking on the role of navigator, co-ordinator and facilitator of this care plan would not be a radical departure for social workers who, due to the advent of personal budgets, are increasingly taking on this case management role,” the report said.

Free social care

It also called on the government to make social care free for people at the end of life, funded by the NHS, in line with a recommendation from the 2011 palliative care funding review.

It said this would be the “single most important step in improving end-of-life care the government could take”, as it would help reduce cost-shunting between the NHS and local authorities, improve continuity of care and reduce delayed discharges from hospital.

The government is expected to implement this policy.

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