Earlier this week I went to my local health centre for a routine blood test. I noticed that the uniformed woman approaching me with the needle drawn had the words “Health Care Assistant” on her badge. This is the first time I have had a sample of blood taken by a person who had no formally recognised training and whose role was unlicensed, unregulated and unsupervised. I proffered my arm—not without a little trepidation. The experience led me to wonder how many other health care assistants were practising in the health service, how many other invasive and non-invasive duties were they routinely undertaking, and how many members of the public were unaware that they were receiving care and treatment from such personnel. The answers to these questions raise further questions concerning quality and safety.

Modern health care is complex and hospitalised patients are often in the acute stage of their illness. Patient throughput has increased and new treatments and technologies have brought with them their own hazards. This is also true within the community where nurses are undertaking home based interventions which were recently only practised in the safety of a hi-tech clinical …