Growing and developing the support workforce

Professional adviser Claire Fordham writes: It has been said so many times already but at the risk of repetition I’ll say it again: as we continue to move through the pandemic, opportunities as well as challenges present themselves. And, thanks to the tireless giving of our workforce, the wider health and care system is much more aware of both the unique knowledge and skills of our profession and the importance of rehabilitation. 

When it comes to rehab we didn’t need Covid-19 to remind us of our contribution to this hitherto unsung hero of healthcare. For others, though, Covid has catapulted the role of rehabilitation in health and wellbeing and our capabilities to the front of their minds. While this new attention is welcome it is accompanied by an ‘ask’ of our workforce to give even more.  

While growing and developing the registered workforce will be crucial to meeting this ask, the time has also come to seriously focus on the development and expansion of our non-registered workforce – our support workers. In my view, if we fail to do this we will not efficiently be able to meet demand, capitalise on the growing opportunities for the profession and push the boundaries of what our registered workforce can deliver. 

Our insight work at the CSP indicates that physiotherapy workforce leaders and managers do see that this needs to happen. A recent CSP survey of physiotherapy managers and leaders in Scotland revealed that developing their support workforces was as or more important to them than developing advanced practitioners, growing community rehabilitation services and expanding student placement capacity. This may feel contentious to our chartered members and it could be that these managers are linking the achievement of other service ambitions to enabling capability in the support workforce.  

This insight lends itself to a growing and compelling narrative that workforce development must be viewed as a continuum, with support workforce development a crucial element. Worryingly, our understanding at the CSP is that, at a local service level, translating this narrative into action – developing the support workforce and enabling them to work in new roles, in enhanced ways and at the height of their capability – is not easy, particularly in the NHS.  

Richard Griffin, a visiting senior research fellow at Kings College London who has spent many years researching and championing the health and care support workforce explains why this might be: 

Claire is right in pointing to the need for the NHS to think about its workforce – their recruitment, development and progression – as one. Sadly, though this is not always the case, as last year’s decision to make the £150-million increase in CPD funding in England available only to registered staff illustrates.  

Uneven access to funding for education was one of the key findings of Camilla Cavendish’s 2013 review of the health and social care workforce; a finding echoed by Lord Willis two years later who said support workers often felt ‘undervalued and overlooked’.  

My own, and others’ research, shows a consistent set of issues that are still preventing the NHS (and social care) getting the most from its 1.5 million unregistered workforce.

These barriers include: 

• lack of clear training and career development pathways 
• inconsistent titles 
• inconsistent entry requirements 
• poor access to high-quality learning that acts as a barrier to transferability 
• lack of consistency in task allocation 
• inconsistent grading 

It’s no wonder support staff can feel frustrated and we are not getting the best out of them. One recently said to me: ‘I know where I want to get to, I just don’t know how’. 

In part it could be argued that this is a symptom of a wider problem with workforce planning in the NHS. In part it also reflects the ad hoc way support roles have developed in the NHS. It is also a result of the problem Claire references: the NHS sees support workers as a separate part of the workforce. A point made by Cavendish who described them as too often ‘invisible’. It’s also a symptom of the wider challenges with vocational education¹. 

There is good news though. Professional bodies like the CSP are championing support roles and providing practical guidance and support to members. There is a growing evidence base of the positive impact of support workers, and there are very positive moves by Health Education England (HEE) and Health Education and Improvement Wales (HEIW) to address long-standing issues. HEE AHP workforce leads, working with professional bodies, are developing tools to help services maximise the contribution of their support workforce and help secure the workforce of the future.  

Challenges remain but the elements needed to increase capacity and capability and progression are there. What we need is for these to be mobilised at scale and at pace. We have islands of good practice, but we need them everywhere. 

Help is at hand: the CSP support worker capability framework 

Central to all of this is showing members how optimising the support workforce’s contribution might be achieved.   We have therefore developed our professional body guidance ‘Optimising capability in the support workforce’   

This resource outlines how support workers might achieve the full capabilities necessary to work at a variety of practice levels and progress in their careers, and serves as a framework to guide the development of support worker roles. It is divided into three sections, all of which cover different aspects. 

Section one outlines: 

• the six domains of support worker capability  
• how we describe and define these capabilities at three levels of support worker practice 
• what we see as higher level of practice with additional responsibilities in a role, addressing the question of how far a support worker might be able to progress in their career 

Section two describes: 

• how physiotherapy support worker capabilities at three levels are reflected in the scope of practice at each level 
• how different levels and scope of practice might be enacted in a variety of roles 
• the formal ways that support workers might work towards developing capability and career progression  
• how accessing qualifications in exercise prescription should be considered as a role and career enhancing option for support workers  
• a pathway for potential career development  

Section three provides: 

• information and signposting for those who aspire to registered physiotherapy practice. 

The capability resource in action 

Karen Lewis, CSP member and deputy chief allied health professional at Dudley Group NHS Trust, has used the optimising capability framework to develop a new role and define the remit for a lead allied health professional support worker.  

‘The development of this role has emerged as part of a collaborative piece between me, CSP associate members and the organisational development team to recognise and optimise the contribution of support staff. This is of particular importance at a time when we face significant challenges within the registered workforce as we respond to the pandemic and deliver the NHS long term plan.  

The post holder will lead a review of current practice across the trust, identifying areas of good practice and areas where there is a need for clarity around responsibility and scope. The CSP’s optimising capability guide will help create clearly defined roles at each band within the six capability domains.

A career pathway with associated learning and development opportunities will be developed so that support workers can plan their career progression through to assistant practitioner roles. Although it is anticipated that many will go onto train to be AHPs, the fundamental goal is to ensure the support workforce can confidently work at the top of their scope and deliver the excellent patient experience we know they aspire to.’  

CSP position on the support workforce 

As a result of these barriers last year the CSP developed a policy position on the support workforce that sets out what we believe needs to happen for the UK physiotherapy support worker workforce to fulfil its potential.  

• many more physiotherapy support workers are needed  
• we need much better physiotherapy support worker data  
• the number of support workers required and the level they work at should be determined by patient and service need locally. We need to enable support workers to do work that registered physiotherapists don’t need to 
• there should be more support workers with enhanced levels of responsibility within robust governance arrangements 
• the CSP framework for physiotherapy support worker role, scope, capability and career development should be used alongside existing country frameworks to increase consistency in capability requirements and role development  
• there need to be clear opportunities and pathways for support workers to develop capabilities 
• each UK country should have a programme of work to develop support worker roles including those at a higher level.   

You can find all our resources for associate members, including guidance useful to guide growth and development of the support workforce in our associate hub 

If you need dedicated support and advice on growing and developing support worker roles you can contact Claire at fordhamc@csp.org.uk