Guiding Principles. Written by Paul Dodd

‘High-quality care and support that is safe, consistent and person-centred’ is what we would all aim to achieve. They are also the stated guiding principles for the ‘Delegated healthcare activities’ from the Department of Health and Social Care and Skills for Health.

The delegation of some activities undertaken by regulated professionals, such as nurses, to care workers, is not new. In fact, it has been happening for some time, and was identified in research by York Consulting in 2022 as providing more ‘timely and flexible delivery of activities, resulting in better continuity and person-centred care’. The benefits are undoubtedly far-reaching. More flexibility and control for those receiving care and support, as well as development and job satisfaction benefits for those delivering it. So the guiding principles bring together key elements which the delegation of care needs to maximise the benefits, maintain safe practice and acquire learning. The principles are:

• Person-centred care
• Governance, regulation and accountability
• Learning, development, skills and competency
• Monitoring and review

As the second principle sets out, good governance systems are needed, both to maximise the benefits and ensure safety. Clear roles and responsibilities, communication and co-produced agreements are key to this.

These principles will also be regulated by the CQC, who have made it clear what they will expect to see. These expectations have been listed as

• People accessing care have been appropriately involved in the decision to delegate care.
• Individual staff taking on a delegated task fully understand what they need to do, are trained and assessed as competent to carry out the task and are appropriately supported.
• The delegating healthcare practitioner retains overall responsibility and management of the person’s relevant healthcare needs and clinical decision-making.
• The delegating healthcare practitioner continues to monitor the person’s condition and the effectiveness of their treatment, including regular review of continuing appropriateness of delegation of the healthcare activity.
• There is an agreed plan on how to respond to and manage risk, including contingency plans.
• Provider records, including people’s care plans, appropriately reflect the person’s needs and how they will be met.
• Provider records are complete, accurate and up-to-date.

Whilst this at first glance may appear onerous, our assurances have been set out. Some of which could clearly be incorporated into existing measures. In times of staff pressures and many competing challenges on services, Delegated healthcare activities present a great opportunity to enhance person-centred care in a seamless fashion across healthcare boundaries, and with the right governance systems in place, gives the service platform to demonstrate ‘outstanding’ service.