Healthcare assistants do jobs which should be done by doctors and nurses, such as inserting intravenous drips, without having to take formal training, a review has found.
The government-commissioned Cavendish review, in the wake Stafford NHS scandal, called for all healthcare assistants to receive standard training.
It said that there are more than 1.3 million frontline staff who are not registered nurses but who deliver the bulk of hands-on care in hospitals, care homes and in the homes of people needing support.
The review says: “Healthcare assistants have no compulsory or consistent training, and a profusion of job titles. This confuses patients, who often assume that everyone is a nurse; and it makes life difficult for some nurses, who are not always sure which tasks they can safely delegate.
“Some HCAs are now doing jobs that used to be the preserve of nurses, even doctors.
“The review met a group of healthcare assistants from a busy A&E who are inserting IV drips, taking blood and plastering. Yet they are paid at three levels below a newly qualified nurse.”
It also found that social care workers were receiving “hugely variable” training, with examples of social care workers being given a DVD to watch at home before “being sent straight out to the frontline”.
“Some employers are not meeting their basic duty to ensure their staff are compentent,” the report, by Sunday Times journalist Camilla Cavendish, said.
Following the Stafford hospital scandal, where it was found as many as 1,200 patients may have died needlessly through routine neglect, Robert Francis QC, who chaired an inquiry into the Mids Staffordshire NHS Trust, recommended a registration system for all healthcare support workers.
The idea was rejected by health Secretary Jeremy Hunt, over fears it would lead to a “bureaucratic quagmire”. Instead, Mr Hunt commissioned the Cavendish review.
The Cavendish review found that in some cases healthcare assistants were “inserting IV drips, taking blood and plastering”, but being paid at three levels below a newly qualified nurse.
Under the review’s proposals, all healthcare assistants and social care support workers should undergo the same basic training and earn a “certificate of fundamental care” before they can handle patients without supervision.
When assistants earn the qualification they should be allowed to use the title “nursing assistant”, the report says.
They should also be given the opportunity to progress into nursing through the creation of a “higher certificate of fundamental care”, the review adds.
Ms Cavendish said: “There are more care assistants than nurses working in England. Many of us will rely on them at some point in our lives, in particular in old age, and we need them to be as good as they can possibly be – especially as some support workers are carrying out procedures which used to be done by nurses, even doctors.
“I have seen many examples of excellent and skilled care, but I have been struck by how disconnected the systems are. The airline industry figured out 30 years ago that the most junior staff could be a critical link in the passenger safety chain. Patient safety in the NHS and social care depends on recognising the contribution of support workers, valuing and training them as part of a team.
“For people to get the best care, there must be less complexity and duplication and a greater focus on ensuring that support staff are treated with the seriousness they deserve – for some of them are the most caring of all.”
Mr Hunt said: “We are determined to build a compassionate health and social care system – one where people are always treated as individuals, with kindness and respect.
“I am very grateful to Camilla Cavendish for the work she has put into this review. It rightly highlights some of the best practices on the front line – where staff with the right values have been recruited and offered the training and support to do their jobs not just competently but also with compassion.
“But it also shines a light on how disconnected the health and social care systems can be and the stark variations in training that staff receive.”
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Improving training and support for health care support workers is not only desirable, it is essential.
“With a rising population of older people, this is a workforce without which the NHS could not function. We welcome this review, in particular Camilla Cavendish’s proposal for a Certificate of Fundamental Care for all health care support workers.
“However, we remain concerned that without mandatory regulation to support this, there is a danger that those staff who are found to be unsuitable could move from one employer to another unchecked. The priority must now be to underpin the recommendations made by Camilla Cavendish in the regulatory structure which governs care.”