CONTROVERSY surrounded the Coronation Street storyline featuring the death of Alma Halliwell from cervical cancer. The character was not offered the support of a Macmillan nurse through the crisis, which would normally be the case. PAULINE HAWKINS investigates the work of an East Lancashire Macmillan nurse.

ALISON James' working day involves meeting people with cancer and talking to them over the phone.

She will see up to 20 people a week and talk to many more, offering care, support and information to help them fight their fear of the unknown and face the future with optimism.

Alison, together with the other 2,000-plus Macmillan nurses across the UK, believes it is important that patients' lives should continue to be of good quality.

And they do not want to be seen as nurses who only appear when a cancer patient does not have long to live.

On the contrary, they can offer support not only to the patient but to his or her family, giving as much time as is required and tailoring their support to the patient's individual needs.

"Sometimes people need fairly intensive input at first and as they adjust, and the symptoms come under control, the need for our input becomes less and less," she said. "Possibly people in the older age range are more likely to accept that none of us lives forever. They may want to live to see their grandchildren grow up. People still make plans to do things. For example, they often have ideas about things they want to achieve or events they want to see, such as the birth of a grandchild or a wedding, or they may be looking forward to a holiday."

Alison has been a Macmillan nurse for 16 months. Employed by Communicare, she is based at the Larkhill Health Centre, Blackburn and has spent the majority of her working life involved with nursing. She and two other community Macmillan nurses, Christine Butschok and John Seddon, cover Blackburn, Hyndburn and the Ribble Valley, a population of 285,000 people. She is not a huge fan of Coronation Street but has kept up with the Alma storyline thanks to a friend who watches the soap avidly. Although the storyline received both brickbats and bouquets -- praise for highlighting the importance of regular cervical screening, criticism of the manner and speed of Alma's demise -- Alison felt some of the background content was misleading. "Not everybody chooses to see Macmillan nurses. Some people feel perfectly well supported by the district nurse. But in Coronation Street it was the practice nurse who went to visit Alma, which was quite unrealistic," she said. And it was also unrealistic for Molly, the practice nurse, to be running around making tea and for Dr Matt Ramsden to be at Alma's bedside when she died.

But the soap did encourage thousands of women nationwide to make appointments for smear tests -- because Alma missed one, and then test results were mixed up, she finally discovered that her condition was untreatable.

The storyline received the backing of Maureen Parsons, head of service development for Macmillan in the North, who said: "Evidence from the National Screening Programme has shown that regular checks are vital in detecting cancer early and improving survival rates. Reminding women through popular programmes like this will help save lives.

"We would not like everyone who has just found out that they have cervical cancer to assume that they, too, are going to die. Many women, particularly those whose cancer is detected early, will be treated successfully and will soon be back to normal." Alison said it was very important for Macmillan nurses to listen to their patients and follow their agenda. "You do get very close to people in this job. We do not provide hands-on, physical care, that's the role of the district nurse, but we provide psychological support. We provide advice on symptom management and concentrate on advising on the best quality of life.

"People often worry about the prospect of becoming debilitated. Some are afraid that the Macmillan nurse is a harbinger of doom.

"There is no magic wand and it takes people a while to adjust to the circumstances, but we can make it a smoother process.

"We support them through the experience, but they are making the decisions.

"The GPs and district nurses are the key workers and we work alongside as clinical nurse specialists offering help which is above and beyond what is routinely available."

Macmillan Cancer Relief not only provides initial funding for Macmillan nurses but also organises programmes promoting healthier lifestyles and offers grants to people who may be suffering financially as a result of contracting cancer.

One in three people will develop cancer at some stage in their life and, while many will be cured, it is inevitable that some will succumb to the disease. Alison would not decry anyone who, knowing their condition was incurable, wanted to continue smoking if they gained pleasure from it in their final months of life.

"People have rights and choices. It is not my position to sit in judgment on other people's lives because I don't know how I would react," she said.