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orking to support patients asthey face the devastation of endstage kidney disease is an oftenhumbling experience. I workwithin a multi-disciplinary team

at York Hospital, employed by the City of YorkCouncil, that includes doctors, nurses,dieticians and psychologists, caring for patientswith kidney disease and their families.

There are a number of treatments for endstage kidney disease, which is when someonehas less than 15% kidney function, but sadly nocure. The treatments vary and include fourhourly sessions of haemodialysis, which is donethrough the blood stream three times a week in

a hospital or satellite unit, or haemodialysis athome following intensive training. Alternatively,there is peritoneal dialysis through a tube intothe stomach, either four times daily orovernight. Some people, perhaps if they have asecondary disease such as cancer, decide to stoptreatment because it is too much for them andthey will die within two weeks.

The treatment of choice for many is atransplanted kidney from a donor. There isalso the option of conservativemanagement, which aims to alleviate someof the symptoms of kidney disease withmedication and dietary advice and can bemore suitable when the person has other

diseases and may be frail and elderly. All treatments carry with them great burdens

and restrictions for the patient and theirfamilies. Not only do patients spend a lot oftime stuck to a machine but they follow arestricted low salt diet, limiting certain foodssuch as coffee, bananas, chocolate and cheese,and are recommended to only drink one litre offluid a day. Fluid builds up in the body betweendialysis treatments and haemodialysis affectsdifferent people in different ways. Patients canfeel awful just before their treatment becausefluid has built up in their bodies and they mayfeel breathless and unwell. Immediatelyafterwards they can feel quite drained, dizzy and

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renal social workMay 2011 • Professional Social Work

A day in the life of a social workerrenal

Cathy Holman, a renal social worker for the past 12 years, explains about the role she performsalongside patients and families, offering insight into the daily routine and the emotional challenges

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19renal social work May 2011 • Professional Social Work

Cathy Holman is a renal social worker at theCity of York Council and part of a team of social workers based at York Hospital. She waspreviously a hospital social worker. To comment on this article please email editor@basw.co.uk

for help with furniture. Eleanor’s finances aremore stable following a successful DisabilityLiving Allowance (DLA) claim, which arebecoming increasingly difficult to obtain for mypatients. I call Jobcentre Plus to speak with theDisability Rights Advisor about two clients whoare on dialysis; one is facing redundancy andthe other is struggling to manage a phasedreturn back to work. We try to encouragepeople to continue working, at least part-time,and indeed we have people who work full-timeand come in for dialysis between 5.30pm and9.30pm.

Many phone calls later I rush to attend therenal ward multi-disciplinary meeting, takedown details of two new referrals and a doctorsigns an Attendance Allowance form for anelderly woman, Katie, who I am working with.I have a sandwich at my desk while lookingthrough the newest referrals before headingback to the hospital to meet up with Katie,her husband and one of the renal doctors totalk about her poor prognosis and to plan herdischarge from hospital. Feeling rather sad, Iwalk down to the renal unit where I meet withone of our younger patients to talk about theplans for her Willow Foundation special daywe have organised to the Goodwood Festivalof Speed. Her enthusiasm makes me feelmuch more positive as I go on to meet Stuartto organise a visit to the renal unit for his ten-year-old granddaughter who lives with him, asshe wants to see where he goes three times aweek.

I have one more visit, to talk with Jina, thewife and carer of a patient with kidney failure,which I will do on my way home. Wecomplete a carer’s assessment together and anemergency carer’s card application formbefore discussing the letter I will write to thehousing department to support the family’sapplication.

On my drive home I think how much I takegood health for granted and look forward tomy yoga class. You do need to have a breakfrom this job. I had last year out on asabbatical to study for an MA in PeaceStudies and Conflict Resolution at BradfordUniversity and we backfilled my post. It canbe emotionally draining working with issuesaround death and dying and supportingpeople who have to face enormousdifficulties and sadness in their lives.

People who are ill often say that the hardestthing is the feeling of being out of control andwithout any power. By meeting in a homeenvironment and listening to the patient’s storyand that of those closest to them, I can help thepatient with the journey through illness,empowering and enabling them to take anactive role in planning and managing care.Renal social workers can act as an advocate or atranslator for the patient and the family. Sooften in busy clinics and wards it is difficult forthe professional, the patient and their family tofind the right words and non-verbalcommunication.

PatientsA typical day starts with an early meeting withrenal specialist nurses to plan a patient andcarer evening. We spend time sorting throughthe replies, putting people into small groups tolook at specific questions around self-care.Around 70 patients and their carer or familymember will join the renal team to look atservice development.

At the renal unit I will meet up with patients,such as Eleanor, a young single parent with twochildren under five who has recently startedback on dialysis. With my help she has appliedfor a housing transfer, has been offered aproperty and we are applying to a renal charity

weak. They may feel well for a day and then thetoxins build up again and it is time to return fordialysis.

Holidays must be planned a long time inadvance because arrangements have to be madeto use a dialysis machine somewhere else.People are incredibly courageous in how theydeal with living with kidney failure.

My role is to give advice and support on arange of personal, emotional and practicalmatters to patients and their families. Many ofthese social work tasks are similar to thoseoffered by social workers or care managersworking with adults in local authority teams.However, I also work with clients fromassessment to care planning, through to review,offering not only care management butprofessional specialised renal social worksupport. My work includes: hospital dischargeplanning, financial and benefits advice, grantapplications, assessments for help at home,referral to occupational therapists andphysiotherapists, looking at employment andfurther training, and liaison and advocacy.

Support and advice to carers and families isan important part of my role, as often the renalteam’s focus will be on the patient and theirhealth needs. I play a central part, within theteam, in end of life care, working together withdistrict nurses, GPs and palliative care teams.

There is a signifcant shortage of social workers based inthe renal social work field. In 2002 the National RenalWorkforce Planning Group recommended that to providean adequate renal social work service would require onewhole time equivalent post per 140 renal replacementtherapy patients – those who have had a transplant ordialysis. But in 2007 BASW’s Renal Social Work SpecialInterest Group (SIG) found there was one whole timeequivalent social worker for every 813 renal replacement therapy patients.

At the core of these workforce problems lie the twin issues of absence of recognition ofthe important contribution of renal social work and lack of clarity over who is responsiblefor funding it. BASW’s Renal SIG believes that the community of renal professionals shouldbe aspiring to a future where every renal service throughout the UK provides a multi-professional renal service, including social work, which works with the humanity of peoplewith kidney disease as well as their illness.

RENAL SOCIAL WORKER PROVISION IN THE UK

IT CAN BE EMOTIONALLY DRAININGWORKING WITH ISSUES AROUND DEATHAND DYING AND SUPPORTING PEOPLEWHO HAVE TO FACE ENORMOUSDIFFICULTIES AND SADNESS IN THEIR LIVES

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