Guidance

'Enhanced care worker' role category

Updated 9 April 2025

Applies to England

This role category describes a group of similar roles. In different places, these roles may be called different things and/or have different role titles.

What people do in their work  

This section outlines the kind of responsibilities someone within this role category is likely to undertake as part of their role. 

People working in this role category support people who need care and support to be able to live their lives and could be across a variety of settings. This includes delivering care and support:

• in people’s own homes
• in a residential setting
• through supported independent living

In some instances, it may require clinical oversight and supervision to ensure practice is safe and effective.

In this role category, the care and support you provide may involve:

• person-centred delegated healthcare activities [note 1] that have been effectively delegated by a regulated healthcare professional (for example, a nurse or an occupational therapist)
• condition specific specialist support

You will undertake recognised, high-quality and auditable additional training to develop the most appropriate skills and knowledge required to meet the specific needs of individuals.

You will not have any specific leadership or supervisory responsibilities and can expect to undertake ongoing competency assessment to ensure you continue to provide high-quality person-centred care and support.

Note 1: a delegated healthcare activity is an activity that a regulated healthcare professional, such as a nurse, nursing associate, occupational therapist or speech and language therapist, delegates to a care worker or personal assistant.

Values

Values are the foundation unpinning the behaviours:

• kind, compassionate and empathetic
• honest, trustworthy and reliable
• respect
• courageous and principled
• see the whole person
• flexible, open and learning
• proud and positive

You can read more about the values in the ‘overview’ document on the Care workforce pathway landing page - see the section on ‘Universal sector values’.

The behaviours people must show (must do)   

Behaviours are the way that values are demonstrated in practice. This section outlines the behaviours required to work within this role category.  

You should show the baseline behaviours from the ‘new to care’ or ‘care or support worker’ role categories. You should also show the core behaviours listed below.

All behaviours should be delivered in the context of person-centred care. 

Core behaviours:

1. Act in an informed and inclusive way, promoting and advocating for the wellbeing and welfare of the people you support.
2. Be adaptable, reliable and take ownership of responsibilities and outcomes.
3. Show commitment to continuous learning and actively seek opportunities for professional development and training to maintain, improve and expand competencies relevant to the person or population drawing on care and support.
4. Exercise professional judgement to assess and manage risk appropriately within the boundaries of your role and support others to do the same.
5. Recognise when an activity or responsibility is beyond your personal competency and actively seek guidance or supervision to ensure safe and effective practice.
6. Take ownership of your own responsibilities within the multidisciplinary team and wider integrated system, ensuring high-quality care and recognising the impact of your and your team’s work on others.
7. Act as a role model by inspiring and enabling others, including through coaching and mentoring

Knowledge and skills people should have

Knowledge refers to what someone needs to understand to undertake the responsibilities of the role. Skills are the ability to apply that knowledge in practice.

This section outlines the knowledge and skills someone working in this role category should know and the things they should be able to do in their job.

Minimum knowledge and skills in this role category 

You should have baseline knowledge and skills brought through from a previous role category. Previous role categories could be:

• new to care
• care or support worker

In some cases, dependent on the setting or service type (for example, all staff could be considered ‘enhanced’), knowledge and skills in the ‘new to care’ and ‘care or support worker’ role categories may be developed in tandem with the knowledge and skills in the ‘enhanced care worker’ role category.

Progression 

You can develop skills and knowledge at this level - see ‘Knowledge and skills breakdown for this role category’ section below for more detail.

You’ll also need to develop specific skills and knowledge to provide particular types of enhanced support to different people. You’ll develop these skills and knowledge on an ongoing basis, depending on what the people you support need. 

Digital skills 

As part of learner knowledge and skill development, you can also work to level 1 (digital skills for all) of the Adult Social Care Digital Skills Framework.

Within this role category, we would expect you to show all level 1 competencies.

You may also use some level 2 competencies (digital skills to go further) within this role category. 

Knowledge and skills breakdown for this role category

Understanding and delivering person-led support (also referred to as personalised or individualised support)

You should:

• demonstrate commitment to develop and consolidate expertise or skills
• proactively coach and share knowledge and best practice with colleagues
• show strong written and verbal communication skills, including the ability to communicate complex information in a clear and accessible way
• be able to support people’s emotional and psychosocial needs and role model effective practice
• be able to use knowledge and understanding of the people you support to advocate for their wishes when they are unable to do so
• know how to build and sustain professional relationships, including establishing accountability and negotiating responsibilities
• be able to work autonomously within your scope of practice and take initiative
• understand your own role, responsibilities and scope (including limitations) of practice
• understand when to ask for additional support and to who and how to escalate
• be confident to speak up when things do not feel right
• know and understand strategies to develop resilience in yourself and know how to seek support to deal with uncertain situations
• recognise and report any factors that may adversely impact safe and effective care provision
• understand what is meant by health inequalities, and your own role in working towards reducing them
• maintain accurate and up-to-date records, ensuring all care interventions and observations are recorded in a timely manner

Specific areas of practice (can do) and suggested learning opportunities

Specific areas of practice

All people working as an enhanced care worker are expected to have the knowledge and skills listed above.

Below are the knowledge and skills you may also need to develop, depending on the setting or needs of a person drawing on care and support.

You should:

• understand the boundaries of your role and not make clinical assessments, judgements or decisions
• be able to seek the guidance and support of healthcare professionals to plan and implement care
• understand the person-centred care planning process and relevant legislative and regulatory requirements, including the guiding principles for effective delegation where appropriate
• understand how to meet the holistic needs of people with co-morbidities and work under the guidance of a healthcare professional to ensure they’re met
• be able to apply fundamental observation skills, including use of equipment and effective recording
• recognise when a person’s condition has improved or deteriorated and escalate as needed, seeking appropriate follow-up as per local escalation procedures
• undertake a range of person-centred delegated healthcare activities, which could include:
  • catheter and stoma care
  • diabetes management and insulin administration
  • nutrition and hydration practices beyond standard care, including specific nutrition support (for example, percutaneous endoscopic gastrostomy (PEG))
  • oxygen monitoring
  • pressure area care
  • supporting someone to use a crisis plan for their mental health
• have a good understanding of clinical terminology and health-related documentation and apply it to care delivery
• know your own limitations in the use of clinical equipment, seeking help where required, and use and dispose of any equipment safely
• understand and apply approaches to care and support for people at risk of distress
• have higher level or tier skills in one or more of the following areas:
  • autism
  • dementia
  • end of life care
  • learning disabilities
  • mental health
  • trauma-informed care and relational working
  • drugs and alcohol
  • sensory impairments (and communication)
  • supporting older people with physical disabilities

Suggested learning opportunities

Unlike the other role categories in the pathway, people in this role category may be undertaking delegated healthcare interventions or other condition-specific support to meet the individualised needs of the person being supported.

The following suggested learning opportunities should be considered alongside tailored training. This includes for delegated healthcare interventions where training, supervision and competence assessment will be provided by a registered healthcare practitioner such as a:

• nurse or occupational therapist
• other registered professional such as a social worker, where appropriate

Qualifications:

• Lead Adult Care Worker (Level 3)
• Lead Practitioner in Adult Social Care (Level 4)

Learning programmes:

• Positive Behaviour Support (PBS)
• Oliver McGowan Mandatory Training
• diabetes management
• coaching, mentoring and supervision

Care Home Advanced Practitioner programmes to support care staff to assist in routine clinical interventions, such as: 

• clinical observations:
  • blood pressure, temperature, urinalysis
  • routine blood glucose monitoring (not management of complex diabetics)
  • recognising signs of deteriorating residents
  • recognising hypoglycaemic and hyperglycaemic individuals
• tissue viability and wound care:
  • tissue viability management of pressure ulcers
  • Waterlow scores and contributing to skin integrity care planning [note 2]
  • management of dressings and contributing to wound care plans [note 2]
  • use of suction device [note 2]
• practical skills:
  • catheter care (not catheterisation) and managing infection prevention and control
  • management of PEG feeding
  • use of suction device [note 2]

Note 2: must be overseen by a registered nurse.

Role category personas

Ashley - residential nursing care

Ashley is a care worker within a residential care home and has worked there for several years. He has completed both his Level 2 and Level 3 qualifications in Adult Care. He routinely undertakes other learning and development relevant to his work within residential care and the people he supports, so he can continue to deliver high-quality person-centred care.

Ashley’s colleagues often seek his support as they value his expertise, and he is happy to share his knowledge and understanding to promote best practice. Ashley’s manager has noticed this and thinks he also displays behaviours which would help him excel in a more senior role within the care home.

During a supervision meeting, Ashley’s manager talks to him about whether this is something he would be interested in, explaining that it would involve undertaking some delegated healthcare activities with oversight from a registered nurse. He explains about the additional training, support and supervision that would be involved to ensure Ashley was able to carry out any activity safely and competently.

They discuss the delegation policy the service has in place, including what the roles and responsibilities are for himself, his manager and the delegating healthcare professional. Ashley’s manager also explains that consent must first be sought from the person drawing on care and support whom Ashley would be supporting in this way, with the reasons for delegating the activity and the benefits to them and their quality of life. She confirms that it’s her responsibility to secure the consent, not Ashley’s. 

Once everyone involved has understood and agreed to the delegation arrangements, Ashley receives approved quality training and competency assessment from a registered nurse and begins to carry out basic health observations, such as blood pressure, oxygen monitoring and respiratory rate.

Ashley enjoys this new element to his role; he feels supported and knows how to escalate any concerns he may have and can see the positive effect it is having on the people he supports.

Richard - homecare 

Richard is an experienced care worker who has recently joined a homecare service which employs their own registered nurse to support in the delivery of complex care packages. Richard has completed his Level 3 Diploma in Adult Care, and other accredited and non-accredited learning with a previous employer, including training to undertake clinical tasks.

After completing a robust induction, Richard undertakes training with the service nurse on a range of delegated healthcare activities, despite having received training previously from a different regulated healthcare professional. Richard is happy to redo the training as he understands that high-quality, person-centred care should be tailored to meet the specific needs of the people he supports. This is outlined on the Skills for Care delegated healthcare activities page.

Richard enjoys being out in his local community, building meaningful relationships and providing compassionate care to the people he is supporting. He also builds a strong relationship with the service nurse and feels confident to contact her with any concerns or to seek advice whenever he needs to.

A new individual requiring care and support joins the service. He needs support with diabetes management and Richard and his manager discuss whether he would feel confident to offer this support with the right training.

Following the discussion, Richard undertakes bespoke training around diabetes management which his service has co-developed. It covers things such as the causes of diabetes, its symptoms and how it affects the body.

The training equips him with the skills needed to support the individual with their diabetes. He undergoes a robust competency assessment at the end, which the service registered nurse is confident to sign off on. Richard goes on to support the new individual with all aspects of their care. He regularly checks in with the nurse initially as he works to embed his new skills and build confidence and then through ongoing competency reviews. 

Claire - supported living

Claire has been in her support worker role in a supported living facility for adults living with learning disabilities, autism, physical disabilities or mental health needs for over a year. She previously worked in a residential setting.

She started in her new role having achieved her Level 3 Diploma in Adult Care and underwent a comprehensive induction at her new place of work. Claire has recently completed a yearly refresher, which includes training on the protection of adults at risk. This is an area where she would like to expand her knowledge and skills.

Claire discusses her interest and desire to develop specialist knowledge in this area with her manager. They work to put a development plan together. Claire’s manager highlights an opportunity for her to train on a PBS foundation programme which is designed for care staff that are supporting people who may be at risk of distress.

He explains that the training will equip Claire with the skills needed to identify what is being conveyed by different behaviours and to determine when intervention might be necessary and at the appropriate level. Claire is very keen to undertake the training and arrangements are put in place for this to begin.

Following completion of the training, Claire feels confident to be part of the support team for a new individual who joins the service with a diagnosis of autism, learning disabilities and mental health conditions. She and the team take time to build a trusting relationship with the person. They develop both a routine and behaviour support strategies. This enables the provision of consistent support where Claire and the team feel confident supporting the person to pursue interests out in the community.

Claire enjoys putting her learning from the programme into practice and begins to think about her longer-term career goals. This includes how she might build on her current skill set and share best practice with her colleagues. She discusses this with her manager and they agree that, as part of her upskilled role, an effective way to achieve this would be to work across different locations within the service.

This is beneficial for all as:

• Claire is able to continue to consolidate and build on her skill set, including developing role modelling and mentoring skills
• the service is able to maximise its investment in Claire’s learning and development
• Claire’s colleagues learn from her knowledge and experience
• the individuals requiring care and support continue to receive high-quality, personalised care