Recommendation 209

Registration for healthcare support workers

Not accepted - agree with principle
A registration system should be created under which no unregistered person should be permitted to provide for reward direct physical care to patients currently under the care and treatment of a registered nurse or a registered doctor (or who are dependent on such care by reason of disability and/or infirmity) in a hospital or care home setting. The system should apply to healthcare support workers, whether they are working for the NHS or independent healthcare providers, in the community, for agencies or as independent agents. (Exemptions should be made for persons caring for members of their own family or those with whom they have a genuine social relationship.)

We intend to achieve the intention behind this by ensuring that organisations have the right staff with the right skills to deliver care in a safe way.

The government understands that the idea of compulsory, statutory regulation can seem an attractive means of ensuring patient safety however, the inquiry demonstrates that regulation by itself does not prevent poor care.  Regulation can be costly and introduce inflexibility into the system. It should only be considered when it is shown that it is the most effective, appropriate, and proportionate means of protecting the public.

We are keeping the situation under review but, currently, there is no solid evidence that demonstrates that healthcare and care support workers should be subject to compulsory statutory regulation, given the safeguards that are already in the system, such as:

  • Care Quality Commission registration, which is being enhanced with the new role of the Chief Inspectors
  • the disclosure and barring service which provides a further layer of assurance by helping employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups that are already in the system, and
  • the requirement on nurses to ensure that when they give a task to a support worker they effectively delegate, supervise and ensure the individual has the right training to do the job

We recognise that there is a need to drive up standards and in 2011 the Department of Health commissioned Skills for Care and Skills for Health to develop a code of conduct and minimum training standards for healthcare assistants and support workers in England, which was published in March 2013.  We welcome the recommendations of the Cavendish Review relevant to the importance of education, training and standards, and these are being developed further.  The importance of this is recognised by the Government asking Health Education England to work with Skills for Care, Skills for Health and other stakeholders to consider how the ‘Certificate of Fundamental Care,’ which will be called the Care Certificate, can be developed.

Where  employers find that a healthcare assistant or social care support workerno longer meets the standards required by the care certificate, Health Education England and the  Sector Skills Councils will set out inguidance therequirements for ensuring that appropriate re-training is given, or other disciplinary action istaken. The guidance will be that the worker in question should not work unsupervised until the problem has been resolved and the employer is confident that their care certificate remains valid.


The Care Certificate sets out the fundamental skills, values and behaviours that healthcare assistants and social care support workers will need to demonstrate in order to provide safe, effective and compassionate care. This will provide a consistent and effective means for health and care providers to satisfy Care Quality Commission requirements that their care support workforce have the right qualifications, skills and experience. It will replace both the National Minimum Training Standards and the Common Induction Standards. Following the successful completion of pilots, the Care Certificate remains on track to be introduced for new healthcare assistants and social care support workers from 1 April 2015. From 2016 all NHS-funded student nurses in England will attain the Care Certificate within their first year of study, if they have not already achieved it. A wide range of employers and staff were engaged with the testing of the Care Certificate, the majority concluding that no radical revisions were necessary. Analysis of feedback received indicated that the draft proposals for the Care Certificate were suitable in terms of content and process

The Care Quality Commission registration requirements state that all providers of regulated activities must ensure that they have the right staff with the right skills, qualifications, and experience to undertake tasks to be performed. Where providers fail to comply, the Care Quality Commission has a range of enforcement powers.

The Disclosure and Barring Service provides a further layer of assurance by helping employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.