This chapter examines the support workforce associated with the allied health professions. We have used the term ‘support workers’ to describe this group because they do not occupy a fully professional space, and they have emerged from the division of allied health labour (Saks and Allsop, 2007; Saks, 2020). We acknowledge that numerous other titles are used to describe workers in this domain of work (Buchan and Dal Poz, 2002; Saks and Allsop, 2007; Bach et al, 2008; Lizarondo et al, 2010). Support workers tend to be vocationally trained and, in many cases, their roles are designed and adapted to meet local requirements.

We distinguish the support workforce from the emerging and existing allied health professions on the basis that support worker roles are derived from the division of labour of existing allied health roles, whereas emerging professions (described in Chapter 4) have generally developed a niche professional repertoire and practise autonomously. Support workers are differentiated from ‘professions’ because they do not have ownership over a unique body of knowledge or theoretical framework that defines their role. Contemporary taxonomies of allied health professions tend to reinforce the notion of the professional project (Larson, 1977) by specifying minimum standards, such as required levels of training, continuing professional development, codes of conduct and quality monitoring standards (Health Care Professions Council, no date; Allied Health Aotearoa New Zealand, no date; Allied Health Professions Australia, no date). As we discuss in this chapter, there are few opportunities for support workers to become allied health professionals unless they meet these requirements.

The delegation of lower-status tasks to an auxiliary workforce is a well-established technique of professions to achieve internal closure (Hugman, 1991). However, the niche areas of practice and lack of recognised areas of specialisation have important implications for the roles of support workers and the advancement of the allied health professions. First, the clinical tasks that can be delegated by allied health professionals fall within a narrow scope of practice that is derived from the niche offering of the specific allied health profession. Second, allied health professions lack the internal professional career hierarchies that enable them to advance professionally as they cast off unwanted tasks to auxiliary staff within their own division of labour, losing some of the advantages of delegation that are apparent within the large professional hierarchies of medicine and nursing.