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Delegated Health Care – Where does it end?

Deborah Sturdy, Chief Nurse for Adult Social Care

Chief Nurse for Adult Social Care, Deborah Sturdy, examines delegated health care in a post-pandemic world.  

The pandemic has been a challenging two years for adult social care. It has changed the whole landscape around the topic of delegated health interventions.  

Delegations to the social care workforce have been happening for many years, but their necessity has increased rapidly since the pandemic, shining a light on the exceptional skills of our frontline social care colleagues.  

As a result of our care colleagues’ amazing skills and dedication during the pandemic, and to address the need for a clear set of practice principles, we have been working with Skills for Care and the wider sector to create a framework for delegation.

We have done this to make sure we embed consistent, safe, appropriate and accountable practice underpinned by knowledge. The discovery phase will be completed this month and it is our intention to publish our findings by April next year.

The work developed through partnership demonstrates the complexity, diversity and range of considerations needed to make this a pragmatic tool, which respects all those involved.

Delegated interventions vary from individual to individual depending on need and require partnership between accountable registrant and care staff. Over recent years, we have seen the development of partnerships and local initiatives between health and social care colleagues. This has included the work in Thameside, which  developed a blended learning programme to help care staff undertake lower level healthcare interventions supported by a robust governance framework, protocols and support. We have also seen the approach in the NHSE led work on the administration of insulin pilots.

What must happen is the appropriate recognition of care colleagues’ skills and the need for ongoing training and development. This requires a safe and effective framework which addresses these issues, such as clinical safety, supervision and oversight, with an emphasis on clinical accountability across health and social care.

As we face global recruitment challenges for health and care staff, we need to invest in upskilling through a robust Knowledge and Skills Framework, which sets out competencies, required skills and the professional expectations of each distinct social care role. The ambition to create this is set out in the Workforce White paper and it is imperative to the success of effective partnership working.

With the emergent Integrated Care Systems (ICS), we have opportunity to drive the change needed to effectively develop skills, acknowledge and experience across the system. Systems can use current flexibilities to commission care and make this change. 

The social care workforce is often underestimated in its ability to be agile and responsive. Often creative and solution focused, the long standing relationships and trust built with those in receipt of care means approaches can be personalised and managed in the best way to meet individual needs. The right person delivering care in the right place is essential to system success, minimises multiple staff visits and maximises our collective workforce capacity.

The registered practitioner has the accountability, responsibility and oversight of care at all times. It is why there must be confidence in the learning and skills training of those delegated to, coupled with robust oversight. Learning needs to be adapted and refreshed to maintain clinical quality and safety. A framework will help us create that assurance. 

By developing a consistent approach, we will enable better care for those who need it, delivered by those who know the person best and have their confidence. It creates opportunities to develop our staff and develop enhanced roles which are remunerated appropriately. This is not dumbing down or diluting roles, it is in fact enhancing care and expanding opportunities for individuals as care recipients and care givers.

The development of a delegation framework, which supports consistency and quality, could also provide ICS’s with a real test bed in re-engineering resources. It could help them to align health and social care partnerships, making them available to appropriately remunerate the skills of social care colleagues as we support those in our care.

We will learn from the work already underway and create a better, safer system for all.  

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