Recommendation F209: Registration of healthcare support workers
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
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.)
In brief (written by this site)
The Inquiry recommended establishing a compulsory registration system for healthcare support workers. The Department of Health and Social Care (DHSC) and NHS England stated in commentary of September 2024, published in February 2026, that this recommendation was not accepted by the Government (DHSC and NHS England, Feb 2026). The Thirlwall Inquiry legal team found in May 2024 that the Government had not accepted the recommendation, noting its reliance on training standards and the Care Certificate rather than compulsory statutory regulation (The Thirlwall Inquiry legal team, May 2024). The department had previously reported in February 2015 that the Care Certificate remained on track for introduction in April 2015 to set out fundamental skills, values, and behaviours for support workers (Department of Health, Feb 2015).
Sources
AI-generated summary of the record on this page, checked by a second model and automatic checks, 1 Oct 2026. The record below is the sources' own words.
Government response
Not accepted, however 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 2011the 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’ (now the Care Certificate) can be developed.
Where employers find that a healthcare assistant or social care support worker no longer meets the standards required by the Care Certificate, Health Education England and the Sector Skills Councils will set out in guidance the requirements for ensuring that appropriate re-training is given, or other disciplinary action is taken. 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.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England say not accepted (27 February 2026)
This recommendation was not accepted by the Government.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Not accepted”. Table row: section 18.2 No. 209, PDF page 531.
Department of Health and Social Care says in progress (11 February 2015)
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.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
Earlier statements on delivery (2)
Department of Health and Social Care (19 November 2013)
Not accepted, however 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.
Department of Health and Social Care (19 November 2013)
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:
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was not accepted by the Government.
In the January 2014 Hard Truths report, the Government said that regulation by itself did not prevent poor care, and in fact could be costly and introduce inflexibility into the system. The Government stated that there was no solid evidence to demonstrate that healthcare and care support workers should be subject to compulsory statutory regulation. The Government instead referred to the code of conduct and minimum training standards for healthcare assistants and support workers in England, published in March 2013.
In the February 2015 Culture Change report, the Government referred to the introduction of a Care Certificate for new healthcare assistance and social care support workers from 1 April 2015, with the Care Certificate setting out the fundamental skills, values and behaviours that healthcare assistance and social care support workers would need to demonstrate.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 209, PDF page 493.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding