Healthcare support workers should be subject to regulation by the Nursing and Midwifery Council in one of 290 recommendations from the Mid Staffordshire Foundation Trust public inquiry.
Inquiry chair Robert Francis QC said HCAs should not allowed to deliver personal care to patients in any healthcare setting without first being registered.
He has also demanded a national code of conduct and a national set of standards for training of HCAs who he said should also be clearly identified and distinguishable from a registered nurse.
In his report, which makes a total of 290 recommendations, Robert Francis QC said the Nursing and Midwifery Council should be in charge of regulating the HCA workforce but he also called on the Department of Health to launch a nationwide system to “protect patients”.
It should be a national entry-level requirement for student nurses to spend a minimum period of time, at least three months, working on direct care of patients. A satisfactory completion of this should be a pre-condition for continuing training, Mr Francis argues.
The report also calls for nursing students to be recruited based on values with “constant support and incentivisation” for nurses, “which values the work they do.”
Mr Francis says nurse education should be reviewed to ensure sufficient practical elements that ensure trainees have a “consistent standard” and he suggests the NMC should develop an “aptitude test” for student nurses.
He also calls for the Department of Health and the NMC to develop the idea of a Responsible Officer for Nursing, and for a system of annual revalidation similar to doctors to be created with nurses having to demonstrate key skills and knowledge and include feedback from patients.
Ward nurse managers should not be office bound and should know about care plans for each patient, Robert Francis said. They should be visible to patients and staff alike and act as a role model and mentor to other nurses.
A key recommendation was for each patient to be allocated for each shift a key nurse responsible for their care and this nurse should be present at every interaction between the patient and the doctor.
Mr Francis also backed the use of a cultural barometer on wards and backed further efforts to develop a tool for assessing the needs for minimum staffing on wards.