A delegated healthcare activity is a clinical task that a registered healthcare professional hands over to a care worker to carry out for a specific person. Common examples in home care include enteral (PEG) feeding, administering rescue medication for epilepsy, catheter and stoma care, and blood glucose monitoring.
Done well, delegation keeps people at home and out of hospital. Done badly, it is one of the fastest routes to harm, and to a poor inspection.
The national guiding principles
Skills for Care, the Department of Health and Social Care, CQC and partners published guiding principles for delegated healthcare activities in May 2023, updated in November 2024. They centre on four ideas: delegation should be person-centred, clinically appropriate, safe and effective.
What inspectors will look for
- A clear decision: who delegated the task, why it was appropriate for this person, and who remains clinically accountable.
- Person-specific competence: evidence that each carer was trained, observed and signed off for that task, for that person.
- Review: a date when competence and the delegation itself will be reviewed, and evidence that reviews happen.
- Escalation: carers know exactly what to do, and who to call, if something is not right.
- Records: each time the task is carried out, it is recorded clearly and consistently.
Where providers fall down
- Training certificates held centrally, with no link to the individual person the carer supports.
- Sign-offs that expire without anyone noticing.
- Relief or bank staff covering a visit without being signed off for that person's tasks.
- No written escalation route, so carers default to calling 999 or, worse, waiting.
A simple test: pick any person you support who has a delegated task. Can you show, within five minutes, every carer who is allowed to do it, when they were signed off, and when that sign-off expires?
A six-point evidence checklist
- A delegation policy that follows the national guiding principles.
- A task register for each person, naming the delegating professional.
- Competency assessments per carer, per person, per task.
- Expiry dates and automatic reminders for reassessment.
- A written escalation route in every care plan.
- An annual audit of delegation, with actions followed through.
How Eviqa can help
Eviqa Advisory writes delegation and competency frameworks for complex and domiciliary care providers. Eviqa Assure records delegation per person and per task, with expiry alerts, so the five-minute test is always a pass.
Source: Skills for Care: delegated healthcare activities, the guiding principles.