Macmillan Cancer Support July 2017 Review date: June 2019

For those working with people affected by cancer

Alison Wyatt, Macmillan Specialist Oncology Physiotherapist Endorsements

We are grateful that this framework has been endorsed by:

Document endorsed by

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 2 Endorsements Contents

Foreword 4 Forewords from professional bodies 5 Acknowledgements 7 1.0 Introduction and background 8 2.0 Purpose and scope of the Macmillan Allied Health Professions Competence Framework 9 3.0 The benefits of the Macmillan Allied Health Professions Competence Framework 10 4.0 How to use the framework 12 5.0 The Macmillan Allied Health Professions Competence Framework 14 5.1 Levels of competence 14 5.2 Communication and leadership competences 15 5.2.1 Communication 15 5.2.2 Leadership 16 5.3 The Competence Clusters 17 1. Clinical practice 18 • Knowledge of cancer and its treatment 18 • Contemporary drivers and strategic awareness 19 • Test results, investigations and medicine used in cancer care 20 • Assessment of holistic needs of adult patients living with and beyond cancer 20 • Symptom management 21 2. Care coordination 22 • Personalising the pathway, care plans and treatment summaries 22 • Transition and transfer between services 22 3. Supporting independence 23 • Promoting self-management and behavioural change 23 • Providing information to support self-management 24 • Healthy lifestyles 25 • Helping people to make informed choices 25 4. Interagency and partnership working 26 • The importance of liaison 26 • The role of different healthcare organisations in different sectors and settings 26 5. Professional practice 27 • Research, audit and service evaluation 27 • Service development 28 6.0 References 29 Appendices 30 Appendix 1 – How the competence framework was developed 30 Appendix 2 – Links to other competency frameworks 31 Appendix 3 – Other published work that has informed the development of this document 32 Appendix 4 – Examples of evidence to meet competences and underpinning education 33 Appendix 5 – Contributors 34

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 3 Contents Foreword

I have always been interested in rehabilitation and the wide variety of roles that Allied Health Professionals (AHPs) provide to help patients and their families maximise their improvement and lead as full and active life as possible. than AHPs who play a significant this way, AHPs need to have a role in helping patients and their detailed knowledge of cancer, the families manage the effects of treatments and the care pathways cancer and its treatments. Whilst available. They need to know the allied health professions have who the other members of the uniquely different roles, they also multidisciplinary team are and have common themes within how they can help. They need their working practice. They all a sound knowledge of the best work towards establishing good practice available. relationships with patients, carers and the multidisciplinary team; This competence framework will they provide high quality clinical be of value to those delivering, interventions and encourage planning and developing independence through a self- services and roles including management approach; they AHPs at all stages of their career, It was acknowledged in the share learning and expertise service managers and those recent Macmillan Thinking across and between teams and commissioning both education 1 Differently report that AHPs work naturally across different and clinical services. Whilst not have a critical role in supporting organisations, sectors and settings. focusing on individual professions, people affected by cancer and There has never been such a it can be used alongside very often provide specialised critical time when we need to focus other professional frameworks, support. The lack of a recognised on being adaptable, innovative standards and guidelines and I career pathway for AHPs wishing and flexible to the changing NHS encourage all of you to build an to specialise in cancer as well as and social care context. understanding of how improving the importance of building more competences can enhance the capacity in the AHP workforce has I strongly believe that people patients’ experience of cancer led to Macmillan developing a affected by cancer should have care. competence framework for AHPs access to AHPs. People who have working with people affected by a cancer diagnosis, their carers’ cancer. and families need help, support Dr Fran Woodard and guidance to help them Executive Director In my role at Macmillan, I see through what could be a traumatic of Policy and Impact, amazing work taking place across period of their lives. AHPs are Macmillan Cancer Support the country, where services are best placed to encourage people adapting and being creative in the affected by cancer to maintain continuously changing healthcare independence. To ensure that landscape and none more so patients are empowered in

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 4 Foreword Forewords from Professional Bodies

‘It is great to see orthoptists named in this document and we encourage readers to use the link to the British and Irish Orthoptic Society (BIOS) competency standards’. Claire Howard, lead of the BIOS stroke and neuro rehabilitation special interest group

‘The Society and College of Radiographers (SCoR) is pleased to offer its endorsement of these competencies demonstrating their support of this initiative contributing towards improving and ensuring high quality care for cancer patients by providing details of the skills and knowledge AHPs require to provide safe, effective and accountable care to people affected by cancer. Although not detailing our professions’ core role (delivery of radiotherapy) they are suited to therapeutic radiographers in a variety of roles including those at advanced practice and consultant level such as clinic, information and support roles in pre-treatment, on-treatment review, follow-up care and into survivorship at both advanced and consultant level practice. Consequently we welcome their availability for use when appropriate and relevant, in conjunction with existing professional competence frameworks, standards, guidelines and the Skills for Health National Occupational Standards’. Sarah James, Professional Officer, Society and College of Radiographers

Penny Wosahlo, Chair of the Royal College of Occupational Therapy Specialist Section for HIV, Oncology and Palliative Care is excited to see an AHP collaborative approach to cancer competencies that can be flexibly applied depending on role and level of work with people with cancer. ‘The Royal College of Occupational Therapy and their specialist section for HIV, Oncology and Palliative Care fully support and endorse the Macmillan AHP competencies. AHPs often share a body of knowledge, skills and approaches that increasingly cross the individual AHP profession boundaries. Uniting those specific to cancer into a single competency document really demonstrates the breadth of what it is AHPs offer in this field and provides clear governance and expectations to ensure a truly competent AHP workforce going forwards.’

‘The Society of Chiropodists and Podiatrists are pleased to endorse the Macmillan AHP Competency Framework. By utilising this and our own existing professional standards and competencies podiatrists who work with patients who have cancer whatever their level of involvement or role now have clear pathways to competency in this field.’ Katie Collins and Sharon Gray, Society of Chiropodists and Podiatrists

‘In 2016 the UK Oncology Nursing Society (UKONS) was involved in the development of a Career and Education Framework for Cancer Nursing. This comprehensive and detailed document was designed to improve the standards of cancer care across the United Kingdom and was widely supported and positively received by the cancer nursing community. Given this encouraging experience, UKONS warmly welcomes the publication of the Macmillan Allied Health Professions Competence Framework. The value of competency frameworks is in their contribution to the support, guidance and of those engaged in the treatment and care of people affected by cancer. This is achieved by harmonising job roles, education levels and practice expectations; by offering a structure for career development, training and education whilst providing information to service providers and commissioners regarding learning opportunities and educational programmes for healthcare professionals. It is incumbent upon all health care professionals that they are transparent in practice and unequivocal about the standards to which they aspire and adhere. This document is to be welcomed in that it articulates these competencies in a way that makes this a reality.’ Richard Henry, President UKONS

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 5 Forewords from Professional Bodies ‘The British Dietetic Association (BDA) is delighted to endorse these standards that provide a framework for improving practice and patient care in cancer, palliative and end of life care. The AHP competency framework demonstrates the shared values and competencies that AHPs share at all levels in particular proactive and enabling care. Along with professional standards they will support dietitians and their colleagues to provide effective, safe and patient centred care.’ Sue Kellie, Deputy Chief Executive, BDA

Executive committee members of the Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC) have worked on this guidance for on AHP competencies in collaboration with Macmillan. The document we hope shall have a great impact on rehabilitation in cancer and palliative care services. This competency document in conjunction with professional competency frameworks, guidelines and standards is a positive step in the development of AHP roles in the care of people affected by cancer. We are pleased to endorse and support this document. Dr Jackie Gracey, ACPOPC Chairperson 2017

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 6 Forewords from Professional Bodies Acknowledgements

Special thanks to the project task and finish group – June Davis, Dr Anne Johnson, Julie Latimer, Tony Banach, Libby Potter, Professor Diana Greenfield and Jackie Turnpenney – and the many allied health professionals who contributed and responded constructively to the consultation requests and attended the consultation workshops.

Sincere thanks are extended to Professor Diana Greenfield and the team who developed the Competency Framework for Nurses2 for their willingness to share their work as a platform on which to develop of the Macmillan Allied Health Profession Competence Framework.

The task and finish group would also like to thank the senior nurses, who are members of the Macmillan consequences of cancer and its treatment (CCAT) community of influence who have worked alongside the project.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 7 Acknowledgements 1.0 Introduction and background

The Macmillan Allied Health Professions Competence Framework (MAHPCF) for those working with people affected by cancer is the first competence framework for UK allied health professionals (AHPs) working with people affected by cancer. This MAHPCF is designed for A competence framework individual will need to adhere use by and with registered AHPs describes the knowledge, skills 100% to the competences outlined including; art therapists, dietitians, and performance required by in this document. The MAHPCF drama therapists, music therapists, individuals to be effective in their will also link to the Macmillan occupational therapists, orthotists, job role and will be determined Quality Standards currently under prosthetists, orthoptists, paramedics, by their amount of contact with development. physiotherapists, podiatrists, people affected by cancer and radiographers (therapeutic and their families, relatives and The MAHPCF aims to underpin diagnostic) and speech and carers. Healthcare organisational the developments in policy and language therapists working with objectives set out “what” an practice that are consistent with people affected by cancer. individual needs to achieve and each UK nation’s programmes for the competence framework sets transforming cancer care all of The primary intention of out “how” an individual needs to which involve developing integrated the MAHPCF is to support work to achieve these objectives. care models within communities managers, teams and individuals and primary care. The roles and by identifying appropriate This framework has been skills across the broad range of competences in a number of designed to complement the AHPs adds significant value to the specific areas that apply to the earlier Macmillan Cancer Support patient pathway and also ensures majority of AHPs working with document, A Competence that rehabilitation is at the heart people affected by cancer. The Framework for Nurses2 and of cancer, palliative and end of information contained within identifies five key clusters of life care. This MAHPCF has been the framework should assist competences that are relevant to designed with flexibility in mind to individuals and organisations the needs of people affected by be used by all AHPs working with to use competence to support cancer, their families, relatives people affected by cancer in any recruitment, workforce planning and carers. The MAHPCF can be setting. and development, career used alongside the Macmillan progression and role design Values Based Standards3, which and to help them consider both emphasise the development of individual and team needs to more equitable relationships ensure that people affected are between staff and patients, being effectively supported. and with existing professional It is hoped that the MAHPCF competence frameworks, standards will be widely adopted and and guidelines and with the Skills help educate the workforce by for Health National Occupational informing academic curricula Standards4 (rehabilitation) where and professional development appropriate to individual roles. programmes as well as Whilst this framework covers highlighting the skills required to many aspects of work AHPs provide safe, effective, high quality undertake, it is not intended to be and accountable care for people a definitive or instructive list of all affected by cancer. that an individual must achieve or aspire to. It is unlikely that an

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 8 1.0 Introduction and background 2.0 Purpose and scope of the Macmillan Allied Health Professions Competence Framework

The purpose of this project was to develop a competence framework for AHPs working in cancer, palliative and end of life care regardless of the setting in which care was delivered.

AHPs play a fundamental role consultation period (see ‘How have a level of knowledge in the provision of active and the Competence Framework was to achieve registration and enabling care whether in hospital, Developed’, Appendix 1). The this is enhanced through on- primary care, community, hospice need to provide consistency of role going continuing professional or in people’s homes and there is expectations, language and skills development. AHPs working in an increasing need to help people has been voiced many times. It cancer, palliative and end of take real control of their condition. makes sense to have one common life care are required to have a set of competence criteria to cover significant level of post graduate Faithful et al5 outlined the job roles as this will help to ensure knowledge to fulfil their roles: necessary shift to proactive cancer that the key criteria managers use care, supported self-management to select and recruit individuals are • behavioural skills – most and collaborative management if also used to manage and monitor professions and organisations patient’s long term consequences their performance and will help to recognise sets of behavioural of cancer and its treatment are to focus training and development on skills be addressed. Robb6 made the where it is most needed. case for cancer care, especially the • experience and qualifications after-care post acute treatment, AHPs have professional – these validate an individual’s to shift to a culture that is a qualifications and their varied capability by certifying elements chronic illness focused with self- roles require them to continuously of skills and knowledge or management and lifestyle advice. develop professional skills, by providing a practical Interventions provided by AHPs behavioural skills and knowledge. demonstration of capability. can have a significant impact Their experience and qualifications The right experience also acts across the whole patient journey validate their overall capability as a powerful force for learning from diagnosis, through active as clinicians. Competences are thereby enhancing capability. treatment, living with and beyond comprised of: cancer, through to palliative and Although this framework relates end of life care. The MAHPCF • professional skills – defined only to AHPs working with adults aims to provide competences by the profession concerned affected by cancer, it does include applicable to all stages of care. and encompassed in ‘scope of competences to help facilitate the practice’ smooth and effective transition The production of this document from young people’s services to has been widely supported by • knowledge – allied health adult services. AHPs during the engagement and professionals are required to

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 9 2.0 Purpose and scope of the Macmillan Allied Health Professions Competence Framework 3.0 The benefits of the Macmillan Allied Health Professions Competence Framework

The main benefits of the MAHPCF for AHPs, their managers and clinical and education commissioners are described in the table below.

AHPs Managers Clinical Commissioners Education commissioners Performance is Managers can It provides a framework It provides a framework assessed against a manage resources for leadership and for leadership and well defined set of more effectively accountability at all levels7. accountability at all levels7. skills, behaviours and by recruiting and knowledge. retaining the right people to the right jobs.

Improves Improves Improves communication Improves understanding communication and communication and and understanding of roles when considering the the understanding of the understanding of when commissioning new development of the AHP roles between AHPs, roles between AHPs and existing services. workforce working with their manager and and their manager. people affected by cancer. wider members of the multidisciplinary team.

Establishes a Managers are able Provides a baseline Identifies areas that the framework for to assess transferable for discussions about workforce needs to be constructive feedback skills and manage skill service provision and competent in to support at specified intervals. mix across services. developments. delivery of services for people affected by cancer and support continuing professional development plans.

AHPs are clear about Employers are able Workforce details will Workforce details will how they are expected to identify required enable benchmarking with enable benchmarking with to perform their jobs. behaviours regardless other services and help other services. of career background. inform development of service specifications.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 10 3.0 The benefits of the Macmillan Allied Health Professions Competence Framework AHPs Managers Clinical Commissioners Education commissioners Appraisal and Helps in the Emerging health needs Emerging health needs can recruitment systems management of can be targeted with be targeted with appropriate are consistent, fair and day-to-day staff appropriate staff with the staff with the appropriate open and helps provide performance appropriate skills and can skills and can support clear direction for constructively, fairly support decisions about decisions about skill mix learning new job skills. and promptly. skill mix.

There are clear links Links can be made Workforce requirements Resources for training, between effective between effective and outcomes can be development and education individual inputs individual inputs negotiated between can be targeted. to work, team and to work, team and commissioners and organisational organisational providers. performance. performance.

Processes are Processes are Helps to facilitate effective Provides a framework to measurable and measurable and partnerships across inform post registration standardised across standardised across teams, voluntary agencies, education commissioning. organisational organisational community resources and and geographical and geographical the independent sector to boundaries. boundaries. ensure resources are used efficiently8.

Outlines potential Provides effective Contributes to and informs professional management support. contract details to support development and service specifications and career progression. service level agreements.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 11 3.0 The benefits of the Macmillan Allied Health Professions Competence Framework 4.0 How to use the framework

The MAHPCF is: As an AHP the MAHPCF can: As a line manager the MAHPCF • applicable across the care • enable care and information to can: pathway from diagnosis, through be shared across different health • establish levels of performance active treatment, living with and settings beyond cancer, through palliative • determine competences for those and end of life care • help standardise care working with people affected by cancer • focused on all needs of patients, • motivate staff by setting their families and carers as challenging objectives and • identify gaps in an individuals equal partners including providing positive feedback or a team’s knowledge for care medical, psychological, social provision and emotional needs. The • support continuing personal and environment in which care professional development (CPPD) • inform the development takes place in is not generally as part of the requirements of of new roles by informing specified, only that care plans the Health and Care Professions job descriptions and role are provided and shared across Council (HCPC)9 registration specifications organisations and professions. requirements. Types of The competences in this evidence can consist of having • manage succession planning by framework can be interpreted an up-to-date and accurate identifying individuals capable of and applied across a range of record of their CPD activities, progressing to the next level settings, sectors and professions appraisal interviews including 360 degree appraisals, case • support and inform appraisals • designed to be used in studies, verification of practice and continuous personal and conjunction with quality and structured observation of professional development. standards and competence practice. See appendix 5 and frameworks available at the for a full list of CPD standards, As a clinical or education allied health professional bodies visit the HCPC website commissioner the MAHPCF www.hcpc-uk.org/cpd can: • applicable to all AHPs who work • identify the skills required to for at least part of their time with • help inform and direct AHPs develop cancer services which people who have or have had to move from one level of can be helpful to commissioners cancer. competence to another. A and providers physiotherapy framework10 published by the Chartered • assist in the strategic Society of Physiotherapy, development of learning and suggests that progression from development programmes one level of practice to the next targeted at specific clinical areas. is based on changes in three different dimensions: complexity; For the wider organisation the predictability; sphere of MAHPCF can: influence. Together they inform • identify gaps in skills and inform the extent of an individual’s learning and development personal autonomy and could programmes. be considered when discussing improvements in performance.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 12 4.0 How to use the framework The MAHPCF is not: • set out to determine grades • likely to be applicable to ALL for specific roles. Indeed some AHPs ALL of the time AHPs will be working across the different levels within the • designed to cover all the framework – ie a competent competences that individuals level in some aspects of their will need in their professional work and specialist or highly roles. Individual organisations specialised in others. It is will have policies and procedures anticipated that individuals which are mandatory for their working at specialist and highly workforce to meet corporate specialised will have acquired all governance standards and or most of the competences at AHPs should follow these. the preceding level/s These will include for example health and safety, information • designed to cover children and governance, manual handling, adolescents apart from during infection control and safe transition to adult services guarding. Competences relating to these do not form • intended to meet the learning part of this document and needs of the unregistered should be identified separately workforce. in discussions between line managers and staff

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 13 4.0 How to use the framework 5.0 The Macmillan Allied Health Professions Competence Framework

5.1. Levels of competence The MAHPCF includes the The competence levels can be defined as follows: range of skills and knowledge required by AHPs* (Therapeutic Competent Radiographers see footnote) This level can describe either newly qualified graduates at the threshold working with people affected by of their career or AHP clinical staff who are experienced in their own cancer. The competence levels are field but have little or no post graduate experience in working with described at three levels: those with cancer. (ie they may be a clinical specialist in neurological • competent rehabilitation however are not a specialist when dealing with a varied • specialist caseload including people with brain tumours). The NICE Guidance, • highly specialised. Improving Supportive and Palliative Care for Adults with Cancer8 describes this as level 2, and the case load of people affected by cancer An individual’s progression is generally < 25%. The activities at this level are relatively straight through the levels will depend on forward to perform and do not present significant issues of complexity their access to and engagement or uncertainty, nor deal with a high level of risk. with learning and development opportunities. Specialist This level describes experienced AHPs with basic level training in working with those with cancer who are at a senior level. The specialist level is equivalent to level 3 in the NICE Improving Supportive and Palliative Care for Adults with Cancer8. Level 3 describes an individual AHPs case load of people affected by cancer as being between 25–50%. Activities at this level present some issues of complexity and uncertainty and may require the management of significant areas of risk.

Highly specialised This level describes advanced allied health practitioners working predominantly or exclusively with people affected by cancer and with higher level training. Highly specialist is equivalent to Level 4 in the NICE Improving Supportive and Palliative Care for Adults with Cancer8. AHPs working at this level lead and manage situations which present high levels of complexity and uncertainty, often associated with a high level of risk. AHPs working at this level often provide clinical leadership and have a wider geographical profile, including clinical credibility at regional and sometimes national level.

*It is acknowledged that Therapeutic Radiographers training is entirely focused in radiotherapy and the care of patients with cancer, and therefore these competency level descriptors do not entirely fit with their professionally defined competences.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 14 5.0 The Macmillan Allied Health Professions Competence Framework 5.0 The Macmillan Allied Health Professions Competence Framework

5.2. Communication and leadership competences For the purposes of this competence framework, leadership and communication are an integral part of the roles of all AHPs at all levels and are not seen as separate competences.

5.2.1. Communication Effective communication is essential to the application of competences. It is particularly important where complex information has to be relayed and where different decisions regarding treatment options are to be made, for example, when treatment options change and difficult messages about palliative and end of life care have to be delivered. Some situations are ambiguous or uncertain. There may be emotions and distress. Specific consideration should be given to communication as a method of:

• supporting and enabling therapeutic relationships with people and their families

• ensuring that the patient, family and carers are fully aware and understand the implications of treatment options

• understanding all aspects of self-management

• enabling effective team working.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 15 5.0 The Macmillan Allied Health Professions Competence Framework 5.0 The Macmillan Allied Health Professions Competence Framework

5.2.2 Leadership AHPs work in complex healthcare The MAHPCF does not attempt organisations with ever changing to define leadership behaviours boundaries and pressures. but draws the reader’s attention Leadership is key to effectively to the NHS Leadership Academy, managing complex teams, Healthcare Leadership Model11 multidisciplinary relationships (http://www.leadershipacademy. and making the most of limited nhs.uk/resources/) which outlines resources and it affects both the nine dimensions of leadership the culture and environment behaviour: of the workplace. The way that individuals manage themselves is • inspiring shared purpose a central part of being an effective • leading with care leader. It is vital to recognise • evaluating information that personal qualities like self- • connecting our service awareness, self-confidence, • sharing the vision self-control, self-knowledge, • engaging the team personal reflection, resilience and • holding to account determination are the foundation • developing capability of effective leadership behaviour. • influencing for results • increasingly positive experience of care and service.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 16 5.0 The Macmillan Allied Health Professions Competence Framework 5.0 The Macmillan Allied Health Professions Competence Framework

5.3. The Competence Clusters The clusters of the MAHPCF and the subsections within each cluster are set out below. 1. Clinical practice 2. Personalising the care 4. Interagency and This cluster describes the pathway partnership working broad comprehensive range of This cluster focuses on the role This cluster focuses on complex knowledge which underpins the of the AHP in coordinating and care being delivered across need for clinical interventions integrating person-centred care, agencies by effectively managing to support the complex needs care planning that ensures that relationships and facilitating of people affected by cancer. multiple disciplines and agencies professional cooperation which will It includes the foundation and can be accessed and the transfer enhance the patients experience context in which clinical practice of care including the transition and ensure their needs are met. is delivered, the additional between teenage and young adult knowledge, understanding and (TYA) and adult services. The subsections in this skills that AHPs need to work with cluster are: people who have cancer and the The subsections in this a. the importance of liaison complexities of the late effects of cluster are: cancer and its treatments. a. care plans, surveillance plans b. the role of different healthcare and treatment summaries organisations in different sectors The subsections in this and settings. cluster are: b. transition and transfer between a. knowledge of cancer and its services. treatment 5. Professional practice This cluster focuses on recognising b. contemporary drivers and 3. Supporting the need for AHPs to maintain strategic awareness independence continuing professional This cluster focuses on AHPs development and to use current best practice to achieve optimal c. results, investigations and being at the heart of supporting outcomes for patients and their medication used in cancer people to take real control of their condition by avoiding secondary families. d. assessment of holistic needs of problems and supporting them The subsections in this adult patients living with and to maintain levels of health and cluster are: beyond cancer function for as long as possible. a. research, audit and service evaluation e. symptom management. The subsections in this cluster are: a. promoting self-management b. service development

b. providing information to support c. support and development of self-management healthcare professionals

c. healthy lifestyles d. using clinical data and information. d. helping people make informed choices.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 17 5.0 The Macmillan Allied Health Professions Competence Framework 1. Clinical practice

1a. Knowledge of cancer and its treatment

Competent Specialist Highly specialised 1. Knowledge of cancer, cancer 6. Has a comprehensive 11. Has an in-depth knowledge treatments and their potential knowledge of symptoms of the potential late effects long-term effects. associated with cancer, cancer consequences appropriate treatments and late effects within to own client group/specialty own specialty area. (eg lymphoedema, endocrine, bone health, cardiac toxicity, psychosexual issues, fertility, dental health, early menopause).

2. Knowledge of the range of 7. Knowledge of the potential 12. Knowledge and physical, psychological and current and long-term physical, implementation of specific social consequences of cancer psychological and social interventions to manage complex relevant to own area of practice. consequences of cancer and its physical, social and psychological treatment. consequences of cancer and its treatment.

3. Knowledge of late effects 8. Knowledge of the range of 13. Knowledge of emerging complications, treatments and care pathways from diagnosis, pathways, evidence and interventions common to own through active treatment, living best practice nationally and area of practice. with and beyond cancer, through internationally to be able to inform to palliative and end of life care. clinical practice at a local level.

4. Demonstrates knowledge 9. Knowledge of the wide 14. Provides specialist interventions of the psychological effects of range of local and national to address the psychological cancer and its treatment on organisations and networks impact of living with a cancer individuals, which could include involved in providing services for diagnosis. loss of confidence, fear of people living with and beyond recurrence and impact on day to cancer treatment. day life.

5. Demonstrates some 10. Recognises the 15. Has an in depth understanding knowledge of loss (of function manifestations of grief and of the knowledge and skills and/or cognitive ability), grief assists family and other health required to manage bereavement and bereavement (whether and care professionals to effectively across the health and this is following death or anticipate and cope with their social care teams and able to loss of functional ability) and reactions. situate practice in change theory. communicates effectively.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 18 1. Clinical practice 1. Clinical practice

1b. Contemporary drivers and strategic awareness

Competent Specialist Highly specialised 1. Awareness of the influences on 5. Awareness of the wider 9. Influences effectively at a cancer service delivery at a local, influences of national policies, strategic level in the delivery of regional and national level and plans and priorities on cancer service plans and policies for where to locate the cancer plans service delivery at a local, regional those with cancer and evidence of for the improved delivery of local and national level and able to strategic involvement. services. identify key documents.

2. Has an awareness of legal 6. Uses relevant legislation 10. Application of key drivers frameworks governing cancer and in practice and supports and into practice across cancer work/employment, including the educates others in raising pathway and disseminate these as Equality Act (2010)12. awareness of the legal frameworks appropriate in own service. governing cancer and work/ employment including the Equality Act (2010)12.

3. Demonstrates an awareness of 7. Demonstrates the use of a 11. Leads the development of and able to identify some of the wide range of local and national resources, information and local resources and information resources, information and directories to meet local service available to help signpost people directories of services to signpost needs and leads the dissemination living with and beyond cancer to people living with and beyond as appropriate. local services. cancer.

4. Demonstrates an awareness of 8. Demonstrates different 12. Leads service improvement the approaches used to engage approaches used to engage and initiatives for people at all and gain the perspectives of gain the perspectives of service stages of the cancer pathway service users, carers and relatives users, carers and relatives affected from diagnosis, through active affected by cancer. by cancer to develop services that treatment, living with and beyond meet patient’s needs and able to cancer, through to palliative and provide evidence of involvement. end of life care. Able to focus on the importance of integrating the perspectives of service users as a key driver.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 19 1. Clinical practice 1. Clinical practice

1c. Test results, investigations and medicine used in cancer care

Competent Specialist Highly specialised 1. Demonstrates an awareness 3. Understands the role of 5. Leads and develops services and knowledge of tests and risk stratification in ongoing based on a risk stratified approach investigations commonly used surveillance for people living with to care in collaboration with the in cancer care in own area of and beyond cancer. wider multidisciplinary team. practice, including rationale for their use and the normal ranges of results.

2. Demonstrates awareness 4. Has awareness and 6. Where applicable, prescribes and knowledge of medications understanding of the health medication within own scope of commonly used in own area of related impact of medication used practice and recognises the limits practice relating to cancer, cancer in cancer and end of life care of own knowledge and skill. treatment and late effects care. (eg chemotherapy, radiotherapy, [Link to ‘A Competency Framework This will include indication, mode hormonal therapy, analgesia) for All Prescribers’13] of action and adverse effects of including the side effects, and the medications. signposts patients to appropriate teams for management of medicine related issues.

1d. Assessment of holistic needs of adult patients living with and beyond cancer

Competent Specialist Highly specialised 1. Has an understanding of the 3. In collaboration with the 5. Works collaboratively with Holistic Needs Assessment (HNA) individual, uses the Holistic others to develop and implement process, including the physical and Needs Assessment to identify the HNA and the range of psychosocial components, and its and prioritise needs which assessment tools and clinical implications for practice together require support and informs the guidelines that are required for with the individual’s concerns and development of an appropriate people living with the effects of priorities for care. plan with defined outcomes and cancer and its treatment across disseminates as appropriate. organisations.

2. Conducts therapy assessment 4. Assesses the impact of cancer 6. Acts as an expert resource using assessment tools linked to diagnosis and treatment on for other health and care evidence base. lifestyle and future employment professionals when dealing needs and interventions with complex and challenging appropriately. situations relating to assessment, interpretation and appropriate evidence based interventions.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 20 1. Clinical practice 1. Clinical practice

1e. Symptom management

Competent Specialist Highly specialised 1. Demonstrates an awareness 6. Provides interventions for 11. Is instrumental in developing of the principles of symptom symptom management and guidelines and pathways to management in relation to cancer, interventions common to own facilitate effective symptom cancer treatments, common late area of practice for individuals management across health, social effects and complications. living with and beyond cancer and care and voluntary sectors in a promotes self management as seamless manner. appropriate.

2. Identifies the physical and 7. Applies knowledge and 12. Has an in depth knowledge of psychosocial needs associated experience of the needs of the range of tools, interventions with cancer and signposts or refers individuals using cancer, late and services available to support patients as appropriate. effects, survivorship and follow-up physical, psychological and social services to provide. psychological needs and educates the team and support on a wide range of diverse others regarding these as a source issues. of knowledge.

3. Uses local pathways to signpost 8. Supports individual patients to 13. Leads and develops services individuals to appropriate sources develop effective coping strategies that continually improve the of support and information for (eg helps patients to develop pathway for people to ensure symptom management and or approaches to monitoring and that symptoms are managed in seeks advice about this where managing their own psychological a timely, effective and seamless appropriate. wellbeing). manner.

4. Applies knowledge and 9. Identifies when patients have 14. Has the knowledge and understanding of the psychological psychological needs that require expertise to lead services that effects of cancer and cancer referral to specialist services support those with mental health treatments for individuals and their and facilitates this process (eg needs and design resources as families. psychiatric or clinical psychology appropriate. services).

5. Distinguishes between 10. Demonstrates significant 15. Leads and develops services symptoms that can be managed experience and knowledge in that continually improve the with simple measures and those the management and support pathway for people to ensure that require urgent and/or of people with cancer and other that symptoms are managed in a specialist intervention. conditions in a stratified manner. timely and effective manner across all levels of stratified models.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 21 1. Clinical practice 2. Care coordination

2a. Personalising the care pathway – care plans and treatment summaries Competent Specialist Highly specialised 1. Provides individuals with 3. Works with individuals to develop 5. Acts as an expert resource accessible information to support intervention plans, interventions and for other health and care their intervention plan ie crib tailored goals that: professionals when dealing sheet/audio visual material • reflect their priorities and concerns with situations arising from care of signs and symptoms to be • encourage self-care and self- plans (eg different perspectives monitored in relation to cancer, reporting of significant symptoms on treatment decisions between cancer treatments, recurrence or • take into account the individuals and their families) and likely late effects. psychological effects of cancer interventions as appropriate. and strategies to manage this. 2. Recognise and intervenes when 4. Coordinates individualised 6. Ensures services and pathways deviations occur from expected care across sectors and disciplines are delivered appropriately progress and takes appropriate according to the needs identified within own specialty or clinical action including adapting it to in the care plan. field to meet the relative risks or the changing needs ie cancer complications and complexity of recurrence, end of life care. needs.

2b. Transition and transfer between services Competent Specialist Highly specialised 1. Has an understanding of the 5. Supports individuals to develop 9. Leads the development issues facing individuals as they confidence in their ability to cope of services to ensure people complete cancer treatment or are with the transition from secondary are supported to manage the discharged from acute hospital hospital care to self-management transition from acute care to follow-up. and supporting independence. supported self management and self management and between children’s and adult services. 2. Understands the roles of acute, 6. Participates in educational 10. Leads the development of community and primary care programmes for staff involved in local education programmes services play in supporting people supporting patients in different for staff involved in supporting with cancer. healthcare sectors and settings. patients who move across different healthcare settings to affect a safe and effective transfer. 3. Provides information to help 7. Supports individuals to develop 11. Leads and monitors the individuals navigate services to confidence in their ability to cope development of services to ensure ensure they are aware of the with the transition from acute people are supported to manage changes in care and service hospital care to self-management the transition from tertiary and provision associated with the and supporting independence and secondary care services to transition of care between sectors. acts as an advocate as appropriate. supported self-management and self-management. 4. Provides information, liaison 8. Liaises and advises on cases 12. Leads and develops strong and support to community, highlighted by community, primary partnership working with all primary care staff and other care and other health and care key stakeholders in a local area health and care professionals for professionals once people are at and acts as the expert in this the management of on-going home. area demonstrating effective symptoms beyond acute care and communication across complex hospital follow-up. organisations.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 22 2. Care coordination 3. Supporting independence

3a. Promoting self-management and behavioural change Competent Specialist Highly specialised 1. Has an understanding of 3. Teaches individuals to carry out 5. Contributes to or creates the factors that might increase self-monitoring and self-care and services that can work in patients’ dependence upon mentors them in the process. conjunction with user groups and services and those that other agencies, including primary foster independence and self care and voluntary sector services management (eg ongoing across complex organisations for physical consequences of cancer patient’s benefits. and its treatment, difficulty with psychosocial adjustment, risk of late effect complications, co-morbidities).

2. Identifies health beliefs and 4. Works in partnership with 6. Develops interventional lifestyle risks that could influence individuals to recognise symptoms programmes to enable individuals compliance with care instructions that require further advice and/ to develop the knowledge, or advice. or investigation and advises confidence and skills to take more them about the options available responsibility for self-management for accessing appropriate and make healthy lifestyle choices. interventions.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 23 3. Supporting independence 3. Supporting independence

3b. Providing information to support self-management Competent Specialist Highly specialised 1. Applies knowledge of the range 5. Directs individuals to relevant 9. Works with other teams of services available to support support and information networks, and agencies to advise on the and guide individuals across online information or non-text development of information to the care pathway (eg voluntary based information, about the wide support people living with cancer agencies, health promotion range of issues that may affect and palliative care needs and services and support groups). them following cancer treatment, involves users in information including work and financial development. matters.

2. Identifies and explains any 6. Uses specialist knowledge 10. Develops strategies and benefits and risks arising from to provide consultations via interventions to enable individuals individuals’ decisions about their alternative media (eg telephone, to optimise their ability to self- care to enable them to make skype) to individuals as part of manage and evaluates their informed choices with relation to services for people living with and effectiveness and actions this. therapy and healthy lifestyle. beyond cancer.

3. Is aware of local resources 7. Assists in the planning and 11. Leads and develops to signpost to for advice about provision of planned education support groups and identifies finances, return to work and programmes and support groups opportunities/gaps in the provision employment issues. for individuals using cancer of support groups at a local level. services at any part of the care pathway.

4. Evaluates the individual’s 8. Plays a key role in translating 12. Ensures that effective strategies understanding of information clinically related topics into are in place to maximise the (including written, visual and language which is understandable opportunities for self-management audio based information), both for individuals to self-manage and supported self-management. communicates effectively to correct effectively and for the development misunderstandings and gives of patient information. further information when required including explaining complex medical terminology in lay terms.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 24 3. Supporting independence 3. Supporting independence

3c. Healthy lifestyles Competent Specialist Highly specialised 1. Signposts individuals to local 3. Works in partnership with 5. Develops systems and processes services that support healthy living individuals to develop tailored to identify factors that may exclude (eg exercise facilities, walking plans of care to promote healthy or deter individuals from accessing groups, adult education classes, lifestyle behaviours that meet their the range of cancer support smoking cessation groups, priorities and concerns. services available to them. supported self management, mindfulness group) whilst acknowledging and respecting their individual decision making.

2. Directs individuals and family 4. Enables individuals, who want 6. Supports other team members members to appropriate agencies to change and adapt healthy to understand models and and information sources that lifestyle behaviours, to develop concepts related to health- support high-risk individuals within realistic short and long-term goals related behaviour change and to cancer, survivorship and late and focused plans for achieving recognise the ‘teachable moment’ effects services. behaviour change. with supporting theories.

3d. Helping people make informed choices Competent Specialist Highly specialised 1. Acknowledges and respects 3. Explains the options, including 5. Develops systems and processes the decisions made by individuals the benefits and risks that are to identify factors that may exclude concerning their health and available to individuals in relation or deter individuals from accessing wellbeing in relation to cancer, to their intervention plan to enable the range of cancer support cancer treatments, survivorship them to make informed decisions services available to them. and late effects care. about their care.

2. Makes appropriate decisions to 4. Manages the changing needs 6. Acts as an expert resource seek help and report concerns to and expectations of patients and for other health and care colleagues when an individual’s their families and ensures care professionals when dealing with choices place them at risk. plans reflect the new priorities. complex communication issues ie when an individual’s choices put them at risk.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 25 3. Supporting independence 4. Interagency and partnership working

4a. The importance of liaison Competent Specialist Highly specialised 1. Liaises between service users, 2. Liaises with, signposts to and 3. Coordinates interventions relatives and carers as equal makes referrals to the multi- across agencies and sector’s for partners (where appropriate) disciplinary team and other individuals with complex care when making links to members health and care professionals needs and monitors and audits of the multi-disciplinary team across community and hospital the process. involved in planning an individual settings (eg learning disability, patient’s care pathway to optimise mental health as appropriate interventions. for the patient’s physical and psychological symptoms).

4b. The role of different healthcare organisations in different sectors and settings

Competent Specialist Highly specialised 1. Has a good understanding of 2. Acts as key contact with a 3. Builds partnerships with those the contributions of other health, variety of agencies in relation involved in the care of individuals social care and voluntary sector to current and anticipated needs with cancer and their families services in meeting holistic care of individual patients (eg primary care teams, multi- needs (eg financial, employment, (eg employment, education, disciplinary team, social care, education and emotional support) financial services). voluntary agencies) and actively including anticipated future needs. seeks to build networks for user benefit.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 26 4. Interagency and partnership working 5. Professional practice

5a. Research, audit, data and service evaluation Competent Specialist Highly specialised 1. Accesses appropriate sources 6. Collaborates with those involved 11. Presents posters and papers of evidence to support their own in providing services for people at national and international practice in cancer and palliative living with and beyond cancer conferences and writes for care services (eg journals, to generate ideas for spread publication, leads audits, research, literature reviews, research articles, and adoption of good practice, service evaluation. audits, and arts based practices). research, audits, service reviews and journal clubs.

2. Has a working knowledge of: 7. Demonstrates a detailed 12. Works to advance the • the range of qualitative and understanding of the importance development of a research quantitative methodologies of clinical research and evidence strategy for cancer, palliative available and their purpose based practice and applies to own care and/or living with and • the concepts of validity and area of practice. beyond cancer and leads own or reliability in relation to the collaborative research projects, design of data collection, supporting health and social care collation and analysis students with research supervision. • the processes used to critique a research paper and how to consider the implications for practice. 3. Demonstrates an understanding 8. Applies principles of ethical 13. Actively involves a range of the principles of clinical research good clinical practice in relation of service users in evaluating and can explain to service users to research, audit and service services, applying the principles the meaning of common terms evaluation (eg working within of equality, diversity and anti- and concepts in relation to their local governance systems and discriminatory practice and cancer treatments (eg placebo, policies, informed consent and research projects. randomisation, quantitative confidentiality). and qualitative research, critical appraisal, patient-reported outcomes, informed consent).

4. Uses outcome measures for 9. Interprets and summarises data 14. Evaluates the effectiveness of individuals, groups and services relating to individuals, groups assessment tools and guidelines that enable accurate and of patients and local cancer used locally, nationally and meaningful reviews of progress to services to create information and internationally, as well as own support service aims. knowledge that can influence the data produced in terms of impact clinical trajectory (ie to recognise on patient outcomes and services the need to commence palliative and outcome measures linked to care or end of life services, service key drivers and evidence based delivery and/or affect small scale practice. service improvement).

5. Contributes data to systems 10. Keeps abreast of local and 15. Uses data supported to be used for research, audit national service change in similar information to drive both or service evaluation and cancer/palliative care services small and large scale service understands own contribution to comparing the data and knowledge improvement. these processes. generated against own services.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 27 5. Professional practice 5. Professional practice

5b. Service development Competent Specialist Highly specialised 1. Supports other staff in the 6. Works with individuals and 11. Ensures and monitors that implementation of services for groups who are considered to be services meet the wide range people living with and beyond at high-risk due to their cancer of needs of people living with a cancer. experience and groups of service cancer diagnosis from adjustment users to promote their inclusion to living well after cancer in the development and review (health promotion), to active of services for people living with surveillance and complex symptom and beyond cancer and leads on management. delegated projects.

2. Is aware of policies and 7. Uses specialist knowledge to 12. Influences policies for people procedures relevant to own area contribute to the development living with and beyond cancer of practice in cancer services and of evidence-based policies and at local/regional/national level supports service developments to procedures. and feeds back to own teams/ improve patient outcomes. organisations.

3. Is aware of the commissioning 8. Supports the commissioning 13. Plays a key role in contributing and development of cancer and development of cancer to commissioning agendas, services to meet local needs. services to meet local needs. evaluating the costs and benefits of providing different service models for people living with and beyond cancer.

4. Awareness of the national 9. Leads locally on the 14. Represents services for people guidance for rehabilitation relating implementation of national living with and beyond cancer or to cancer, palliative care and end guidance for services for people own discipline at national and/or of life care. living with and beyond cancer. network meetings.

5. Identifies areas of the current 10. Develops services that 15. Regularly applies and leads service that could be developed continually improve the pathway the development of innovative including identification of the gaps for people and supports lifestyle service models across the and potential opportunities. choices and future employment pathway with a particular focus needs where applicable. on supporting the psychological effects of cancer.

5c. Support and development of healthcare professionals

Competent Specialist Highly specialised 1. Teaches registered and 2. Teaches cancer and/or 3. Has an awareness of the unregistered health and care palliative care related topics at availability of regional and professionals about topics relating undergraduate and post graduate national cancer/palliative care to people living with and beyond level in a range of settings and learning opportunities and leads cancer in the local service in a supports undergraduate AHPs on its introduction for the local range of settings. and organises others on clinical workforce and fosters links and placement. placements of undergraduate and post-graduate AHPs and others.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 28 5. Professional practice 6.0 References

1. Macmillan Cancer Support Thinking Differently. Macmillan’s vision for the future cancer workforce in England. 2017. https://www.macmillan.org.uk/documents/policy/thinking-differently.pdf [accessed Februar y 2017] 2. Macmillan Cancer Support. A Competence Framework for Nurses - Caring for patients living with cancer. 2014. http://www.macmillan.org.uk/documents/aboutus/health_professionals/competence-framework- for-nurses.pdf [accessed November 2015] 3. Macmillan Cancer Support. Macmillan Values Based Standard – Transforming the experiences of patients and professionals. 2013. http://www.macmillan.org.uk/documents/aboutus/commissioners/macmillan- values-based-standard-overview.pdf [accessed May 2016] 4. Skills for Health. National Occupational Standards (rehabilitation). 2003. https://tools.skillsforhealth.org. uk/competence/show/html/id/445/ [accessed July 2016] 5. Faithful, S., et al. Self-reported competence in long term care provision and adult cancer survivors: A cross sectional survey of nursing and allied health care professionals, 2015. International Journal of Nursing Stud http://dx.doi.org/10.1016/j.ijnurstu.2015.09.001 [accessed December 2015] 6. Robb, K. Addressing consequences of treatment – The role of rehabilitation. 2011. European Journal of Cancer. 47, S61-S62. 7. NHS England. Commissioning Guidance for Rehabilitation. 2016. https://www.england.nhs.uk/wp- content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf [accessed September 2016] 8. National Institute for Health and Clinical Excellence. Improving Supportive and Palliative Care for Adults with Cancer. 2004. https://www.nice.org.uk/guidance/csg4/resources/improving-supportive-and- palliative-care-for-adults-with-cancer-773375005 [accessed November 2015] 9. Health and Care Professions Council. Your Guide to Standards for Continuing Professional Development. 2012. www.hcpc-uk.org/cpd [accessed October 2016] 10. Chartered Society of Physiotherapy. CSP Physiotherapy Framework (condensed version). 2013. http:// www.csp.org.uk/professional-union/careers-development/cpd/csp-eportfolio/my-eportfolio/cpd-resources [accessed October 2016] 11. NHS Leadership Academy. The Healthcare Leadership Model, version 1.0, Leeds: NHS Leadership Academy. 2013. http://www.leadershipacademy.nhs.uk/resources [accessed September 2016] 12. Equality Act. 2010. https://www.gov.uk/guidance/equality-act-2010-guidance. [Accessed June 2017] 13. The Royal Pharmaceutical Society. A competency framework for all prescribers. 2016. http://www. rpharms.com/support-pdfs/prescribing-competency-framework.pdf [accessed June 2016]

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 29 6.0 References Appendix 1 How the competence framework was developed

The competences outlined in this document were developed through a nine month engagement process with more than 160 allied health professionals, other health professionals and academics. The first working draft was the result of a thematic analysis of competences outlined in ‘A Competence Framework for Nurses’2 followed by consultation exercises both on-line and face to face in workshops. This document builds on the Competency Framework for Nurses2 and provides a structure for improving AHPs knowledge, skills, training and aspirations in cancer and palliative care.

Literature review

AHP Expert Advisory group/Task and Finish Group meetings

Draft 1 – Online survey of draft competences and layout – AHP Expert Advisory Group, AHP Special Interest Groups, individuals

Draft 2 – Framework produced

Open consultation – request views from professional bodies, special interest groups and at consultation events in London, Manchester, Edinburgh and Belfast

Task and Finish Group review of comments

Draft 3 – Comments incorporated

Main draft framework piloted

Framework finalised

Endorsements sought

Publication

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 30 Appendix 1 Appendix 2 Links to other Competency Frameworks

British and Irish Orthoptic Society. Competency Standards and Professional Practice Guidelines for the Extended Role of the Orthoptist, 2014. https://orthoptics.org.uk/Resources/Documents/Standards/BIOS_ Competency_Standards_Extended_Roles%20Sep2014.pdf [accessed June 2016] Royal College of Occupational Therapists’ Professional Standards and Ethics, 2015. https://www.cot.co.uk/standards-ethics/standards-and-ethics [accessed November 2016] European Journal of Palliative Care. Core competencies in palliative care: EACP White Paper on palliative care education – part 1 Palliative and End of Life Care Competency Assessment Tool. 2013. www.eapcnet.eu/ LinkClick.aspx?fileticket=xc-tl28Ttfk=&tabid=194 [accessed December 2015] Northern Ireland Palliative Care Assessment Tool, 2016. ..\NI Palliative End of Life Care _Competency Assessment Tool (1).docx [accessed July 2016] Royal College of Speech and Language Therapy (members only site). https://www.rcslt.org/about/ publications/overview Teenage Cancer Trust. Competencies. Caring for Teenagers and Young Adults with Cancer: A Competence and Career Framework for Nursing, 2014. https://www.teenagecancertrust.org/sites/default/files/Nursing- framework.pdf [accessed December 2015] The Royal Pharmaceutical Society. A competency Framework for All Prescribers, 2016. http://www.rpharms. com/support-pdfs/prescribing-competency-framework.pdf [accessed July 2016]

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 31 Appendix 2 Appendix 3 Other published work that has informed the development of this document

Benner, P. From Novice to Expert. 2001. Prentice Hall Health. Skills for Health Resources http://www.skillsforhealth.org.uk/resources/case-studies/competence-based-training [accessed June 2016] NHS England.Commissioning Guidance for Rehabilitation. 2016. https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf [accessed March 2016] NHS Wessex Strategic Clinical Networks. Principles and expectations for good adult rehabilitation. 2015. http://www.wessexscn.nhs.uk/files/6714/3469/9995/Principles_and_expectations_for_good_adult_ rehabilitation.pdf [accessed January 2016] Report of the Independent Cancer Taskforce. Achieving World Class Cancer Outcomes: A Strategy for England 2015 – 2020. 2015. http://www.cancerresearchuk.org/sites/default/files/achieving_world-class_cancer_outcomes_-_a_strategy_ for_england_2015-2020.pdf [accessed July 2016] Welsh Government. Modernising Allied Health Professions’ Careers in Wales. A post registration framework. 2016. http://gov.wales/docs/phhs/publications/160926postregistrationframeworken.pdf [accessed September 2016] Whyddett, S. and Hollyforde S. A Practical Guide to Competencies. 2009. Chartered Institute of Personal Development. 2nd Edition.

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 32 Appendix 3 Appendix 4 Examples of evidence to meet competences and underpinning education

Level Evidence Underpinning education Highly specialised • Advisory Board attendance documentation • Advanced Communication Skills • Published academic papers Training • Evidence of participating in and/or leading • Working towards a doctorate research, audit and evaluation • Professional qualifications • Conference presentations/posters/attendance • Post Graduate certificates/ documentation diplomas ie education • Role as mentor/supervisor • Awards achieved or nominated for • Reflections on how knowledge and evidence has been applied in practice • Role as mentor/supervisor • Demonstrates communication at advanced level – complex communication/interpersonal skills Specialist • Documentation to support running focus • Post-graduate study groups, teaching and chairing meetings • Working towards Masters • Production of patient information degree • Designed and set up patient support groups • Communication skills training – etc intermediate level • Awards achieved or nominated for Competent • Consolidation of learning from registration • Professional qualification (HCPC • Own reading registration) • Journal clubs • Accredited CPD modules related • Awards achieved or nominated for to cancer, palliative care and • Portfolio of evidence relating to practice EOL including etraining courses • Communication skills training – foundation level

Learning opportunities are varied and flexible, constantly undergoing change and modifications. Readers are encouraged to log into the main Macmillan website and Learnzone to access current opportunities. http://learnzone.org.uk/

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 33 Appendix 4 Appendix 5 Contributors

Task and Finish Group members

Full name Role Organisation Tony Banach Learning and Development Manager Macmillan Professionals Service Excellence and Support June Davis National Cancer Rehabilitation Lead Macmillan Cancer Support Professor Diana Macmillan Consultant Nurse Sheffield Greenfield Dr Anne Consultant Occupational Therapist & Macmillan Royal National Hospital for Rheumatic Johnson Professional and Senior Lecturer Diseases Faculty of Health & Life Sciences, University of the West of England Julie Latimer Macmillan Learning and Development Manager London Ann Marie Associate Macmillan Development Manager O’Connor Libby Potter Senior Learning and Development Manager Midlands and South West England Jackie Director and Project Manager Rehab Futures Limited Turnpenney

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 34 Appendix 5 Allied Health Professional Expert Advisory Group members

Full name Role Organisation Tony Banach Learning and Development Manager Macmillan Professionals Service Excellence and Support Sandra Clarkson Macmillan Development Manager Macmillan Cancer Support Kathy Cooke Associate Learning & Development Manager Hampshire, Dorset and Wiltshire Louise Davey Lead Macmillan Oncology Dietitian Mount Vernon Cancer Centre June Davis Macmillan National Cancer Rehabilitation Macmillan Cancer Support Lead Charlie Ewer- Macmillan Lead Occupational Therapist, Complex Regional Pain Service, Royal Smith Macmillan Breast Radiotherapy Injury United Hospital Bath NHS Foundation Rehabilitation Service/Clinical Specialist Trust Occupational Therapist Zoe Gale Macmillan Review Radiographer The Christie NHS Foundation Trust Jacqueline Macmillan Learning and Development Macmillan Cancer Support, Northern Hallam Manager England Nikki Hawkins Macmillan Survivorship Programme Lead Macmillan Next Steps Cancer Rehabilitation, Gloucestershire Care Services NHS Trust Jenny Hunt Macmillan Principal Lead Speech & Language Luton and Dunstable University Hospital Therapist, Head & Neck/ENT NHS Trust Sarah James Professional Officer The Society and College of Radiographers Alison Jinks Macmillan Occupational Therapist Dudley Group NHS Trust Dr Anne Johnson Consultant Occupational Therapist & Royal United Hospital Bath NHS Macmillan Professional & Senior Lecturer Foundation Trust & Faculty of Health & Life Sciences, University of the West of England Gerard King Learning and development officer South West Ambulance Service NHS Foundation Trust Carys Kinsella Workforce Development Manager Macmillan Cancer Support Sian Lewis Macmillan Clinical Lead Dietitian Velindre Cancer Centre, Cardiff Karen Morgan Specialist Radiographer Musgrove Hospital, Taunton and Somerset NHs Foundation Trust Catherine Neck Macmillan Cancer Rehabilitation/Recovery North Bristol NHS Trust Package Lead Louise Macmillan Cancer Care Development South Western Ambulance Service NHS Pennington Facilitator Foundation Trust Helen Petley Macmillan Partnership Quality Lead Macmillan Cancer Support Clare Probert Macmillan Speech & Language Therapist Shrewsbury and Telford Hospital NHS Trust

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 35 Appendix 5 Full name Role Organisation Debbie Provan Macmillan TCAT Project Lead and National NHS Ayrshire and Arran AHP Lead for Cancer Rehab Jane P Rankin Physiotherapist Belfast Health and Social Care Trust Barbara Macmillan Cancer Care Facilitator Buckinghamshire Healthcare NHS Trust Reynolds Dr Karen Robb Rehabilitation Clinical Lead Transforming Cancer Services Team, London Jill Scott Registered Dietitian and Associate Learning Macmillan Cancer Support and Development Manager Joanna Fairhurst Macmillan Learning and Development Macmillan Cancer Support Manager Penny Wosahlo Manager, Independent Living Team Farleigh Hospice, Chelmsford, Essex

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 36 Appendix 5 Attendees at Consultation Events in Manchester, London, Belfast and Edinburgh

Full Name Occupation Organisation Leanne Allen Occupational Therapist Cordia Services (LLP) Glasgow Kerry Archer Clinical Lead Physiotherapist Hull and East Yorkshire Hospitals NHS Trust Katie Armour Occupational Therapist Cordia Services (LLP) Glasgow Alison Armstrong Radiology Services Manager The Christie NHS Foundation Trust Laura Bates Macmillan Occupational Therapist University Hospitals of North Midland NHS Trust Paula Bavetta Team leader day services and therapy Isabel Hospice - Welwyn Garden City Sharon Bennett Macmillan Specialist Dietitian Abertawe Bro Morgannwg University Health Board Hannah Berry Highly Specialist Speech and Language Guys and St Thomas NHS Foundation Therapist Trust Yvonne Blom Macmillan Clinical Specialist Physiotherapist NHS Frimley Health Foundation NHS Trust Jill Bradley Lead for Allied Health Professions Northern Health and Social Care Trust Rebecca Oncology Physiotherapist Maidstone and Tunbridge Wells NHS Brennan Trust Christine Brown Acute Clinical Lead - Dietetics NHS Lanarkshire Marlene Brown Advanced Dietetic Practitioner NHS Lothian Donna Bruce Specialist Occupational Therapist St Andrew’s Hospice - Lanarkshire Clare Burke Physiotherapist Queen Elizabeth University Hospital Glasgow Paula Cahalan Allied Health Professional Lead Belfast Health & Social Care Trust Linda Cantwell Community Dietetic Service 5 Boroughs Partnership NHS Foundation Trust Shima Post registration education commissioning Department of Health, Northern Ireland Choudhury lead Anna Maria Macmillan Occupational Therapist Wigan and Leigh Hospice Crabtree Louise Davey Lead Macmillan Oncology Dietician Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust Kirsten Dawson Occupational Therapist NHS Lothian Denise Docherty Macmillan Occupational Therapist/ NHS Tayside Transforming Care After Treatment Allied Health Professional Lead Clare Dorrell Community Occupational Therapist Midlothian Council Maxine Elliot Occupational Therapist NHS Borders Anna Ferguson Occupational Therapist NHS Lothian

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 37 Appendix 5 Full Name Occupation Organisation Heather Finlay Nursing Officer Department of Health, Northern Ireland Ruth Garvie Occupational Therapist NHS Lothian Mandy Gilmore Head of Dietetics and Diabetes Services Southern Health and Social Care Trust Louisa Gilpin Macmillan AHP Nero Oncology Project Lead East and North Hertfordshire NHS Trust Jacqui Hallam Macmillan Learning and Development North & South West England Manager May Hanrahan Physiotherapist NHS Lothian Carmel Harney Assistant Director of AHP Governance, Southern Health & Social Care Trust Workforce Development and Training Emma Hicks Macmillan Occupational Therapist Shrewsbury & Telford Hospital NHS Trust Mary B Hill Macmillan Speech and Language Therapist Wigan and Leigh Hospice Kate Hinchliff Macmillan Occupational Therapist Oxford University Hospitals NHS Trust Joshna Hirani Macmillan Occupational Therapist Royal National Orthopaedic Hospital NHS Trust Sarah Hodge Macmillan Occupational Therapist Northern Lincolnshire and Goole NHS Foundation Trust Lindsey Hughes Improving Rehabilitation Services Programme NHS England Lead Myra Hunter Occupational Therapist NHS Ayrshire and Arran Careen Jackson Specialist Physiotherapist NHS Lanarkshire Debra Jones Palliative Care Occupational Therapist Bolton Hospice Diane Jones Macmillan Specialist Palliative Care Wirral Community NHS Foundation Physiotherapist Trust Paula Kealey Macmillan Strategic Partnership Manager Macmillan Cancer Support Jenny Keane Allied Health Professional Consultant Public Health Agency, Northern Ireland Janice Lang Macmillan Highly Specialist Speech and Pennine Acute Hospitals NHS Trust Language Therapist Sue Lewis Partnership Quality Lead Macmillan Cancer Support Sian Lewis Macmillan Clinical Lead Dietitian Velindre Cancer Centre Lynne Main Specialist Occupational Therapist NHS Lothian Diane Mains Occupational Therapist NHS Greater Glasgow and Clyde Orla Mannion Senior Dietitian The Christie NHS Foundation Trust Peter McAuley AHP Deputy Principal Department of Health, Northern Ireland Lynne McCartney Physiotherapy Services Manager Northern Health and Social Care Trust Mary Community Head and Neck Team Lewisham and Greenwich NHS Trust McClenaghan Dr Patricia Associate Head of School Ulster University McClure School of Health Sciences Euan Allied Health Professional Advisor NHS National Services Scotland McComiskie

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 38 Appendix 5 Full Name Occupation Organisation Rosemary Occupational Therapy Team Leader NHS Borders McCuaig Colette Macmillan Occupational Therapist Western Health and Social Care Trust McCullagh Elizabeth Occupational Therapist NHS Dumfries & Galloway McKean Marianne Advanced Occupational Therapist NHS Fife McLeod Pauline Assistant Head of Clinical Education Centre Health and Social Care Clinical McMullan (Allied Health Professional Unit) Education Centre, Northern Ireland Ruth Mhlanga Service Lead Rehabilitation Team South Tees Hospitals NHS Foundation Trust Stephanie Miles Physiotherapist Pennine Care NHS Foundation Trust Marie Morris Team Leader 5 Boroughs Partnership NHS Foundation Trust Margaret Assistant Director Allied Health Professions South Eastern Health and Social Care Moorehead Trust Charlotte Morrell Macmillan Specialist Physiotherapist Wigan and Leigh Hospice Amy Mountford Physiotherapist Derby Teaching Hospitals NHS Foundation Trust Genevieve Macmillan Senior Learning and Development Macmillan Cancer Support Murphy Manager Linda Murray Dietetic Clinical Team Lead NHS Greater Glasgow & Clyde Hannah Urology Specialist Radiographer The Christie NHS Foundation Trust Nightingale Valerie Norrie Occupational Therapist in Palliative Care NHS Tayside Merette Oslen Occupational Therapy Team Oxford University Hospitals NHS Trust Stephanie Pye Macmillan Physiotherapist Pennine Acute Hospitals NHS Trust Paul Rafferty Head of AHP Services Western Health and Social Care Trust Jyotsna Rai Specialist Physiotherapist NHS Lothian Lesley Sayliss Macmillan Clinical AHP Educator Hertfordshire Community NHS Trust Sarah Scoble Therapy Team leader & Occupational The Princess Alice Hospice Therapist Patrick Sherlock Palliative Care Physiotherapist Marie Curie Joanne Sloan Occupational Therapist Pennine Care NHS Foundation Trust Rebekah Smith Senior Dietician Lewisham and Greenwich NHS Trust Angela Southam Specialist Palliative Care Dietitian Victoria Hospice, Kirkcaldy Rachael Swan Speech & Language Therapist NHS Fife Alex Taylor Churchill Occupational Therapy Team Lead Oxford University Hospitals NHS Foundation Trust Michelle Assistant Director Allied Health Professions & Public Health Agency Tennyson Personal and Public Involvement Elaine Tracey Specialist Occupational Therapist NHS Lanarkshire Mandy Trickett Macmillan Specialist Physiotherapist Belfast Health and Social Care Trust Georgia de Vicq Specialist Dietician Cancer & Palliative Care Royal Cornwall Hospitals NHS Trust

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 39 Appendix 5 Full Name Occupation Organisation Kerry Walker Occupational Therapy Health and Social Care Partnership South Ayrshire Council Karen Walsh Macmillan Speech & Language Therapist Pennine Acute Hospitals NHS Trust Bente Whitby Macmillan Physiotherapist NHS Frimley Health Foundation Trust Kirstie White Senior Practitioner Occupational Therapist East Lothian Council Sharon Wiener- Educational Project Manager NHS Education Scotland Ogilvie Paul Williams AHP Team Lead Oncology Services West of Scotland Cancer Centre Wendy Wilkinson ABM ULHB Occupational Therapist Abertawe Bro Morgannwg University Health Board Hazel Winning Lead Allied Health Professional Officer Department of Health, Northern Ireland Jennifer Woods Senior Occupational Therapist The Christie NHS Foundation Trust

The Macmillan Allied Health Professions Competence Framework for those working with people affected by cancer 40 Appendix 5 As a healthcare professional, you’ll know that cancer can affect everything. Health, relationships, finances, and more. At Macmillan, we’ve been helping to ease the practical and emotional consequences of cancer since 1911. Today you can call on us whenever you feel the people in your care would benefit from extra support.

As the UK’s leading cancer support charity, we can provide a range of services to complement your vital work, giving you the resources you need to help people live as full a life as possible

Working with you, we can be there for people during treatment, help with job and money worries and will always make time to listen if someone needs to talk. Whatever’s needed – be it help with benefit applications or emotional support for the whole family – we can work together to transform how people live life with cancer.

From diagnosis, for as long as we’re needed, we’re here to help you support the people in your care and their loved ones. Visit macmillan.org.uk/professionals for more information about our services.

Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Also operating in Northern Ireland. MAC16800.