Published on 24 July 2024
Crucial staff in the NHS are still undervalued and ‘invisible’. A decade after Camilla Cavendish was first commissioned to write a review of NHS support staff, a survey has found that many challenges remain the same.
By John Gale, Senior Programme Manager at Cheshire and Merseyside Cancer Alliance and Supportive and Assistive Lead at NHSE Aspirant Cancer Career and Education Development Programme (ACCEND).
A survey of NHS support staff by King’s Business School has found there has not been any significant improvements in experiences of work since 2013, ten years after the original Cavendish Review. Many of these crucial NHS staff are “undervalued and invisible”, according to a new report, The Cavendish Review Ten Years On: Are NHS support workers still ‘invisible’?.
The report says that assistant practitioners, healthcare assistants, support workers, physiotherapy assistants and other clinical staff make up 28 per cent of the NHS workforce and are often the staff with the most direct contact with patients and their families. There are currently 389,000 of these support staff in the NHS in England, with another 204,000 needed by 2037 to meet demand.
However, the report – authored by Professor Richard Griffin, Dr Abi Hall and Professor Ian Kessler, of King’s College London – reveals little progress on workforce issues, which were first identified more than 10 years ago, many of which are relevant to the professional cancer care community.
‘Negative consequences for patients and staff’
The authors found issues including limited opportunities for support staff to advance – with just one in five thinking the NHS values them, and more than a quarter (28 per cent) regularly consider leaving their job.
The report says: “Poor utilisation and deployment of this important healthcare workforce has negative consequences for patients, staff, employers, and the NHS as a whole. Addressing the issues the support workforce face nationally, regionally, and locally, would benefit patient care, ease staff workloads, and improve organisational productivity, safety, and patient satisfaction.”
The survey also found support staff suffered from a lack of information about career progression routes, little support from their managers, and poor-quality appraisals and Personal Development Plans. They also believed recruitment, induction and onboarding processes should be improved.
Most people surveyed were enthusiastic about the work that they did (75 per cent), felt proud of it (85 per cent), and believed that they made a difference to patients (83 per cent). They nonetheless believed they could contribute more if they had greater access to occupationally relevant education, time off for study and funding for professional development. Around one in 10 said they had not been able to access any formal training in their whole career with the NHS.
These results are not surprising, and the challenges that cancer navigators, support workers, cancer care co-coordinators and health care assistants face are understandable.
Cheshire and Merseyside Cancer Alliance is committed to improving career opportunities for the supportive and assistive workforce, promoting inclusivity, and fostering avenues for professional growth and advancement, as demonstrated by our work over the past three years and overcoming many recommendations set out in the national paper in December 2021 (which you can read here) and undertaking the national ACCEND Programme across the supportive and assistive levels of practice.
The supportive and assistive workforce is integral to the ACCEND programme and has its own dedicated section on the NHS ACCEND Learning Hub. This has brought together the training and education required for the supportive and assistive workforce, enabling staff to learn and develop, through a variety of training offers and progress on a lifetime career ladder in cancer care.
Change is needed
The report emphasised that support workers believe NHS workforce policy needs to change to address these issues.
It identified that many of these changes were recommended by the initial Cavendish Review, such as common job titles, protected time off for study, protected funding for training, clear careers information, representation of support workers at board level, support to access pre-registration degrees, better quality appraisals, review of pay banding, a national support staff workforce plan and clear task descriptions.
The new report was completed between November 2023 and January 2024, and surveyed 5,255 NHS support staff, with responses demonstrating there had been some limited progress since 2013, such as on the quality of supervision and the clarity around scope of practice.
Camilla Cavendish, Financial Times columnist and contributing editor research fellow at the Mossavar Rahmani Center, Harvard Kennedy School, conducted the original review. She said of the new report: “It is frustrating to see that so many of the issues and challenges I identified 10 years ago still remain. When the NHS faces acute backlogs and staff shortages, it is vital to maximise the potential of all staff.”
Anyone who is employed in a supportive or assistive role within the NHS should be encouraged to visit the ACCEND Learning Hub – which you can access here – and access the Supportive and Assistive Learning Hub, The Foundations of Cancer Care and Primary Care Cancer Care Coordinator Training. They are free to access for all.
We have had 1,573 registered users utilising the ACCEND Supportive and Assistive Learning Hub, which aims to support a standardised career pathway, training and education and capabilities in practice for the supportive workforce in cancer care.
Khandker Manzoor, Project Support for the Supportive and Assistive Level of Practice, highlights that the national ACCEND Supportive and Assistive Steering Group and ACCEND Learning Hub task and finish group are collaborating with partners across the country to launch phase two of the hub. This will include videos, implementation guides and support, and role profiles which supports all staff to use the ACCEND framework in practice.
You can watch the launch of Phase 1 of the ACCEND Learning Hub here. Register on the Cancer Academy here to find out more about the Principles of Cancer Care Programme and see other useful resources for the cancer workforce. You can read the new report here.