NHS patients are receiving an "unacceptable" level of care from a growing army of unqualified healthcare assistants who have taken over nursing roles on wards and in care homes, an independent commission warns.
Basic tasks which were once the job of trained nurses are being carried out by more than 50,000 low-paid and unregulated assistants due to budget cuts and growing demands on nurses' time.
Putting vulnerable patients in the care of well-meaning but "unreliable" nursing assistants raises "serious concerns about public protection", a commission led by Lord Willis of Knaresborough, the Liberal Democrat peer, says in a report published today.
Healthcare assistants are employed for simple tasks like keeping patients fed and hydrated or taking their temperature, but are not currently trained to spot warning signs such as dehydration or rapid changes in body heat.
Patients and families who do not understand the distinction between nurses and unqualified healthcare staff often seek and follow the advice of assistants without realising they have no expertise.
The report recommends training all healthcare assistants to at least NVQ level three – the non-academic equivalent of A-levels – to tackle the "widespread concern" about their growing presence on wards and care homes.
"The commission finds it unacceptable that staff whose competence is not regulated or monitored are caring for vulnerable citizens," the report says. "It is equally unacceptable that registered nurses must take responsibility for supervising colleagues on whose competency they cannot rely."
The report was commissioned by the Royal College of Nursing, to examine the training system for nurses amid concerns about their competence and attitude following a string of "stories of appalling care and mismanagement".
Figures released last month revealed that 43 hospital patients had starved to death and 11 died of thirst due to failures in the most basic levels of care on hospital wards, while 78 died from bedsores. Earlier this year one in three nurses claimed they did not have enough time to help elderly patients eat or go to the lavatory, due to inadequate staffing levels.
By September 2013 all nurses will be required to have degree-level training, which critics have claimed will result in a less compassionate level of care on wards and in homes.
The Willis Commission says there is "no evidence" of a decline in care, describing an all-graduate nursing profession as "not simply desirable but essential".
But the report also raises concerns over the regulation of unqualified staff after NHS managers claimed the new demands on nurses will force them to rely more heavily on unqualified healthcare assistants for basic care.
Previous studies have found a direct link between a lower proportion of registered nurses and a worse quality of care, and concerns are such that the Royal College of Nursing has led calls for systematic training and regulation of support workers.
In 2011 the NHS in England employed more than 53,000 "Healthcare Assistants", accounting for about four per cent of its workforce, and numbers are increasing by six per cent each year.
But the report added that their role is "very varied, sometimes poorly defined and lack consistency across employers", and that the use of alternative titles such as "nursing assistants" or "nursing auxiliaries" means the real total could be higher.
Lord Willis told the Telegraph: "The registered nurses now are doing more highly specialised tasks and it is not good enough to say someone else can do those basic nursing tasks, they are not just add-ons.
"You really have to have people who do not just put food in front of someone, but understand the significance that a patient takes food and hydration. It is not good enough to simply know how to do something, you have to know why you are doing it."
He added that many patients and their families find it hard to distinguish between registered nurses and other ward staff, which "often leads to them making assumptions" based on discussions with unqualified workers.
The report also calls for measures to improve the quality of placements carried out by nursing students, and for newly qualified nurses to be given additional support and mentoring during their first year in practice.
Dr Peter Carter, chief executive of the Royal College of Nursing, said: "Improvements will need to be made to the profession in the future, notably in the regulation of Healthcare Assistants and the need to make all student placements match the very best.
"However the evidence in this report makes it very clear – the way to do this is to continue with nursing as an all-graduate profession. There is no truth in the suggestion that because nurses receive training from universities as well as on the ward they become less caring."
A Department of Health spokesman said: "Public confidence is really important, however in the case of healthcare assistants, there is no evidence that compulsory regulation would lead to higher standards.
"They are supervised by professionally qualified staff, and often by experienced nurses. Regulation does not, in itself, change culture and is no substitute for proper performance management, good leadership and day to day high quality patient care."
A code of conduct and minimum training standards for healthcare support workers will be drawn up by January, he added.
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