Comment

Giving a helping hand to cancer survivors

The support worker’s role in cancer care is valuable, but its scope, criteria and training requirements should be clearer.

The support worker’s role in cancer care is valuable, but its scope, criteria and training requirements should be clearer.

Many services have employed, or are looking to recruit, non-registered staff to support clinical teams in managing the growing number of cancer survivors.

In the context of a cash-strapped health service, this lower-cost solution makes sense. However, there has been little guidance on the scope and criteria of the support worker’s role, and what training and role development is required to ensure it succeeds.

The ‘support worker’ title is one of a number given to members of the non-registered workforce in health and social care. Most of these roles are linked to nursing but many involve the support of a range of allied health professionals. There is also a variation in banding, from band 2 to band 4.

In cancer services, specifically follow up, some support workers undertake nursing tasks, such as surveillance, with variable degrees of supervision. Others are involved in predominantly administrative functions, such as organising health and wellbeing events. Some were created in response to staff vacancies, and involve the generic functions of the cancer nurse role; others were created as part of a proactive plan to deliver key interventions in the recovery package (Hughes et al 2014).

Given that the support worker role in survivorship was one of four tested by Macmillan, it may have evolved from the charity’s desire to offer one-to-one support services to survivors. Macmillan’s 2015 evaluation report on this nationwide project focuses on overall service, however, so it is difficult to determine if the charity’s role profile applies.

Training

We have little evidence that the support worker role is successful in improving the efficiency of specialist staff, but we often assume it is. In our experience, support workers’ productivity depends on provision of the right support, training and supervision. Support is needed in planning the post to ensure the optimal skill mix is identified in specific cancer care teams.

Transparency in job plans is required so that all team members are clear about the aspects of the work that require specialist input and those that can be managed by support workers.

Training and development of non-registered support workers requires further consideration. Health Education England’s Shape of Caring review (2015), which followed the Five Year Forward View (NHS England 2014), examines the future education and training needs of registered nurses and care assistants. It highlights the need for nurses and care assistants to have the education and training they need to support healthcare delivery.

Explicit in the Shape of Caring review is an expectation that nurses and support workers will enable patients with long-term conditions to self-care, and to promote more integrated services by working across organisational boundaries. These are highly relevant priorities in survivorship care.

While these changes are made at a strategic and national level, it is important to consider learning in the workplace. We should ask how well support workers are being supervised and by whom.

Clinical nurse specialists (CNSs) may provide support workers with direction and support, but this work may not have been factored into individual CNS’s job plans. Ideally, such roles are integrated in multidisciplinary teams, where several members can offer close supervision.

There needs to be clear governance of the adopted strategy and clear identification of the scope of practice of each support worker. We advocate further review of this potentially valuable role to optimise its future contribution to care.

About the authors

Claire Taylor is Macmillan nurse consultant in colorectal cancer at St Mark’s Hospital, Middlesex.

Sheila Small is Macmillan lecturer-practitioner in oncology at Mount Vernon Cancer Centre, Middlesex.

References

Health Education England (2015) Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. (Last accessed: April 27 2016.)

Hughes C, Henry R, Richards S et al (2014) Supporting delivery of the recovery package for people living with and beyond cancer. Cancer Nursing Practice. 13, 10, 30-35.

Macmillan Cancer Support (2015) Evaluation of Phase 1 of the One-to-One Support Implementation. Final Report. (Last accessed: April 27 2016.)

NHS England (2014) The NHS Five Year Forward View. (Last accessed: April 27 2016.)

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