Delegated healthcare


support the care of each individual in a professional, person-centred way. During the pandemic, the amount of delegation increased dramatically, as there was a need to reduce footfall into care homes, and people’s own homes. The experience and skills of our care workforce was enhanced by specific training and they willingly and successfully embraced wound dressings, diabetes management, and other activities. There were a number of benefits to this way of working. Individuals were able to receive their care at a time that suited them and from someone that knew them well, nursing teams were available to deliver support in situations which needed their higher skills, and care staff were able to grow and develop. This worked well, provided that staff


were able to access training, supervision, and escalation when they needed it. The delegation framework makes it clear that these are essential for a safe, sustainable, scalable process. There was also a need during the pandemic for observations of temperature and oxygen levels to be taken regularly for all care home residents. It would not have been practical for nursing teams to undertake these observations, but they could be delegated to care staff provided they had clear guidance on who to report to when they had concerns. Observations can form part of a process of monitoring deterioration in care home residents. Care staff under the guidance of clinicians from Enhanced Health in Care Homes teams, with the right upskilling and support, can monitor deterioration in residents and often notice early signs. Early intervention is often possible without the individual having to go to anywhere – which is much better for them and helps to reduce the stress at acute hospitals. Our workforce in care homes and home


care would gladly rise to the challenge of delegated healthcare activities, but it is important that they are recognised as skilled practitioners. This is not just about service providers being able to pay them more, but also about the way that they are seen by health colleagues.


For delegation to be safe, sustainable, and scalable – enabling individuals to receive the best possible care in a timely way – it is important that good governance is followed. This must include an appropriate level of resource as well as training, supervision, and escalation pathways – an element of governance that is often overlooked.


n 26 www.thecarehomeenvironment.com May 2024 Oonagh Smyth


Oonagh Smyth is CEO of Skills for Care. For seven years, she was executive director of strategy and influence at Mencap, leading a directorate of around 500 people across England, Wales, and Northern Ireland. Oonagh has held roles at the Northern Ireland Council for Voluntary Action and the Northern Ireland Equality Commission, and senior roles in Westminster Equalities Partnership and the National Council for Voluntary Organisations. She is a former co-chair of the Care and Support Alliance –


a cross-sector alliance of 80 social care organisations influencing at the highest government levels.


Professor Deborah Sturdy OBE


Professor Deborah Sturdy OBE is the chief nurse for adult social care in England. She represents the social care nursing profession, providing clinical leadership to the workforce.


Working closely with the minister for care and the chief nursing Officer for NHS England, she supports the provision of high quality, joined up care. Professor Sturdy also works with Department of Health and Social Care colleagues, and the wider sector, to develop social care policy for the betterment of the workforce and the individuals and communities they serve. She has had a long and successful


career in nursing, including working with older people and people living with


dementia. She has also provided nursing advice to the Gosport Independent Panel, set up to address concerns about the care of residents in Gosport War Memorial Hospital.


Professor Sturdy has held many roles across health and social care, including clinical practice, management, policy, and research.


Melanie Weatherley MBE


Melanie co-founded Walnut Care in 2002, now one of the largest domiciliary care providers in Lincolnshire, employing over 200 care professionals and providing 600,000 care visits annually. A passionate advocate for the provision of home and community care, Melanie has been the chair of Lincolnshire Care Association (LinCA) since 2016.


Melanie is also co-chair of the Care Association Alliance – a national body bringing together representatives of care associations to engage with the wider health and care system. In 2020, Melanie received


an MBE for her services to social care, honoured for helping set up the Care Home Trusted Assessor Scheme. In a national first, Melanie also led a scheme to train care workers to become nurse associates.


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