Some healthcare assistants are doing jobs which should be done by doctors or nurses but do not have to undergo compulsory formal training, a review into the profession has found.
The NHS's army of support staff is undertaking tasks such as placing fluid directly into patients' veins by inserting intravenous drips or taking blood, but they receive no "consistent" tutelage, the report said.
The review, initiated after the publication of the public inquiry that revealed that the most basic elements of care were neglected at Stafford Hospital, called for all healthcare assistants (HCAs) to receive standard training.
HCAs and support staff are responsible for some of the most basic levels of care in the health service including washing, dressing and feeding patients.
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."
There is no standard training for staff who provide fundamental care in NHS hospitals and care homes. Robert Francis QC, chairman of the public inquiry into the failings at Mid Staffordshire NHS Foundation Trust, recommended a registration system for healthcare support workers.
But Health Secretary Jeremy Hunt refused to initiate full-blown regulation for HCAs, saying that it could lead to a ''bureaucratic quagmire''. He instead commissioned the latest review, led by the associate editor of the Sunday Times, Camilla Cavendish.
The review says there are 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.
It concludes that all HCAs 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.
Ms Cavendish said a register, as recommended by the Francis Inquiry, would not address the issue of training and standards. She told the BBC Radio 4 Today programme: "My view on that is we saw terrible things happen at Mid Staffordshire where nurses were registered. I don't think registration on its own solves this problem. I think what you need is proper leadership and management, which is in every care home and every hospital the employers are held responsible for the quality of those staff and they are held responsible for meeting certain basic standards of competence and care. I think that's more important than just registering on its own."