As care teams take on more delegated healthcare activities, how can the sector build the confidence and safeguards to lead? Jonathan Taylor, Head of Corporate Risks, Health & Care at Howden, shares insights from a roundtable exploring clearer accountability, consistent training and practical standards for safe delegation.
Care teams are taking on more healthcare responsibilities, creating opportunities to support people in familiar surroundings and develop staff skills. But without consistent guidance, providers are navigating an increasingly complex risk environment.
Delegated healthcare activities (DHA) are now prevalent in almost every care setting and are likely to grow in scope. Yet there is little sector-wide structure around how they are delivered.
That gap between opportunity and uncertainty brought experts together at a roundtable organised by specialist insurance broker Howden and healthcare training provider Ashfield Services. Around the table were care provider CEOs and managing directors, alongside representatives from charities, the legal profession, the Royal College of Nursing and Care England.
The discussion revealed a growing consensus: social care has the expertise to help shape the future of delegated healthcare—and should take the lead.
Growing responsibilities
Care providers are increasingly being asked to undertake activities that might previously have been considered healthcare responsibilities. These include:
- Administering insulin for individuals with diabetes.
- Catheter and stoma care, including changing stoma bags.
- Percutaneous Endoscopic Gastrostomy (PEG) feeding.
- Wound dressings and pressure area care.
- Oxygen monitoring.
- Administration of certain prescribed medications under delegated arrangements.
One of the biggest challenges is that a definitive list of delegated healthcare activities does not currently exist. No regulatory body has drawn one up or taken responsibility for doing so. Many in social care see this as a major barrier to safety and accountability.
Meanwhile, the number of activities being delivered is increasing exponentially. As Martin Green of Care England pointed out, this is a lasting shift.
“Delegated health activities are an important part of the NHS’ vision for the future, which means they are here for the long term.
“If we look at the NHS 10-year plan, delegation is absolutely central to the devolution of services to communities rather than staying always in healthcare settings.”
Taking ownership
Rather than waiting for regulation, what could social care put in place itself?
Once a defined list of activities has been established, one proposal discussed was a flexible red, amber and green classification based on risk and complexity. A similar approach is already in place in the Netherlands.
The group agreed that this should be a practical starting point rather than an exhaustive prescription. Decisions must remain person-centred, taking account of the individual’s condition, the competence of the person delivering care and the circumstances involved.
Such a model could be a first step towards more cohesive, sector-led standards. Currently, providers encounter inconsistent approaches across the CQC, integrated care systems and local authorities, including regional variations.
That does not mean those organisations are getting it wrong. It means the lack of a unified approach creates additional risk—and was a source of considerable frustration around the table.
Who carries the risk?
Delegation can blur the lines between the NHS, commissioners and care providers. A central point in the discussion was that a registered professional cannot delegate accountability simply by delegating a task.
Yet participants described care workers being asked to perform clinical tasks without sufficient training or supervision. This increases risk and undermines confidence. Some workers find it difficult to say no or speak up when they feel unsure, even after completing training.
The risks extend beyond any one person or organisation. They affect the person receiving care, the professional delegating the activity, the reputation of the care business and, potentially, its directors and leaders.
Providers should discuss these responsibilities with their insurer, exploring how risks can be mitigated and whether existing cover is sufficient for all the activities undertaken. Advice from a specialist broker is crucial.
Training beyond the classroom
Robust, ongoing training is essential if delegated healthcare is to work well. Completing a course is only part of the picture: staff also need continuing competency checks and supervision.
Matthew Attfield at Ashfield Services said: “There remains a major training gap in social care, along with a lack of ongoing competency checks and supervision.
“The sector needs a new approach to training. There has historically been a lack of funding, which is often restricted to NHdS-employed staff, leaving care providers adrift.”
One solution discussed was a national tariff for DHA, linked to training and competencies. This would help connect the responsibilities providers take on with the resources needed to deliver them safely.
An opportunity for joint leadership
Although the discussion was politically agnostic and focused on DHA, Prime Minister Andy Burnham’s public attention to social care was seen as an opportunity to take the conversation to a higher level.
There are existing projects to learn from. In Greater Manchester, three of the 10 boroughs established formal delegated healthcare programmes. Their experience highlights the importance of senior joint leadership, dedicated programme roles, structured governance and sustainable funding.
These are practical foundations on which a more consistent approach could be built.
A shared vision
The willingness of influential people across the sector to come together, discuss the challenges openly and look for solutions is an encouraging start.
Martin Green concluded: “It’s really important to recognise that our sector has so many highly skilled people within it. We are able to achieve delegation very successfully if we have real clarity about what the expectations are and the lines of accountability.”
Lara Bywater, Managing Director of LDC Care Company, set out what success could look like:
“The end goal is a better system for all. One that means people can receive support and care in their own home, rather than being taken to a clinical environment.
“But also, one that takes pressure off the NHS and formally recognises and offers career opportunities for social care staff.”
That vision brings the opportunity into focus: better experiences for people receiving care, stronger career opportunities for staff and less pressure on the NHS. The next step is to turn that shared ambition into clear standards, practical support and consistent action.
