According to the Cavendish review, healthcare assistants do not have to undergo compulsory formal training and can work unsupervised carrying out tasks usually done by doctors and nurses.
The independent review was set up by Government in the wake of the Francis inquiry into Mid-Staffordshire NHS Foundation Trust.
Among its recommendations, it states that all HCAs must get a certificate of fundamental care before they can work unsupervised.
Call for changes
HCAs provide some of the most personal and fundamental care to people with long-term conditions, but the review found the quality of training and support that care workers receive in the NHS and social care system varies between organisations.
It has called for the opportunity for talented care workers to progress into nursing and social care through the creation of a higher certificate of fundamental care.
After completing the certificate, the review recommends HCAs be renamed as nursing assistants.
The review recommended trusts empower directors of nursing to take full responsibility for the recruitment, training and management of healthcare assistants.
It also called for the legal processes for challenging poor performance to be reviewed so employers can be more effective in identifying and removing any unsatisfactory staff.
Disconnect
Chief executive of the NHS employers association Dean Royles said the Cavendish review was a welcome contribution to the debate on how the NHS can best deliver high quality care.
"[The review] recognises the work employers have put in to ensure nursing support staff are an essential, well supervised part of the team. Strong recruitment, induction and development programmes are widespread in the NHS, helping ensure healthcare assistants are supported to do a fantastic job," Royles said.
"Nursing support workers are often unappreciated by society, often working in very challenging circumstances, and it's important this is being acknowledged. But they provide a crucial role in ensuring compassionate care. They are as much a part of patients' experience of the NHS as registered nurses or doctors."
Camilla Cavendish, the review author, said while she had seen "many examples of skilled and excellent care" she was "struck" by how "disconnected" the systems were.
"The airline industry figured out 30 years ago that the most junior staff could be a critical link in the passenger safety chain," she said.
"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."
The Government will provide a formal response to the review, along with its response to the Francis Report, in the autumn.
