This is revealed in the first nationwide survey of nursing auxiliaries and healthcare assistants. Hospital managers, currently grappling with pounds 200m deficits and major shortages of registered nurses, have turned to unqualified ancillaries, say Keele University researchers. But their survey, which covered 250,000 staff in UK hospitals, shows that many of these staff suffered high levels of stress, worried about performing skilled tasks which they were not qualified or legally entitled to do. Only one in 10 said they they were always supervised.
Last month the chief executive of Eastbourne Hospital resigned after a damning report into the death of two patients which revealed that a ward of 40 patients was being run by just one qualified nurse and three auxiliaries.
In psychiatric units, unskilled staff, without training in proper restraint techniques, are frequently asked to stand in for nurses. In 1994, psychiatric patient Oswald Morson died after he was involved in a struggle with nurses and healthcare assistants who held him in a neck-lock. Staff alleged he died of a heart attack but the coroner recorded an open verdict.
The survey, carried out by Keele University's department of industrial relations, found that staff commonly feel that they are exploited and patient care is being compromised.
Stress and the heavy workload are leading to an exodus of older assistants, while low pay and patchy access to training for vocational qualifications are a deterrent to young people.
Geoff Martin, London convenor of the health union Unison, which represents NHS staff, said hospitals were putting patients and staff at risk. "This arrangement suits some hospitals because it keeps staff costs lower, but they are hitting a position when they get to a dangerous ratio of nurses to ancillaries. That puts patients at risk and compromises our members. When you consider that the NHS is looking at a pounds 200m debt this year, the easiest way to cut it is to cut qualified staff."
Carole Thornley, who led the survey, Out of Sight, Out of Mind, said skilled nursing tasks such as handing out drugs, taking blood, administering heart massage and even giving opinions on doctors' ward rounds, were becoming a regular part of unqualified staff work.
She said strict national registration was needed "to reassure the public and prevent unsafe practices". But she also wants the Government to reflect the work being done by dedicated but unqualified staff who, she says, are "amongst the poorest-paid workers in society".
Dr Thornley added: "At the moment it is difficult to distinguish between someone who has worked in the NHS for 20 years and is highly competent, and someone who has only just joined and needs extensive training."
Turnover among healthcare assistants exceeds the already alarming rate for nurses. Dr Thornley said that, unless action was taken, the prognosis for hospital staffing was bleak.
"If the Government and the public want a professional nursing workforce, then pay rates need to reflect this. At present, non-registered nursing staff are paid poverty wages and usually gain no extra reward or recognition for national vocational qualifications achieved."
Warrington North Labour MP Helen Jones agrees that regulation is vital: "These staff have an awful lot to offer the NHS but they get little in terms of wages, training or recognition. In the extreme case at the moment there is nothing to stop a nurse who has been struck off for endangering patients coming back onto hospital wards as an assistant."