NHS England has published updated guidance on the delegation of healthcare tasks to personal assistants.
The updated guidance can be read here: Personal health budgets: delegation of healthcare tasks to personal assistants
Peoplehub recognises that the guidance is intended for practitioners and Integrated Care Boards, who retain ultimate responsibility for ensuring that any delegation of healthcare tasks is done appropriately and safely.
Peoplehub’s focus is to enable people with long term health conditions and disabilities to have choice and control over the decisions that matter most to them. This guidance has great potential to support personal decision-making.
Due to the wording used at various points in this guidance, it also carries a risk of unintentionally limiting a person’s choice and control.
We therefore feel it’s important to highlight the following important points:
▣ Page 7 of the guidance states that:
“The decision to delegate a healthcare task to a PA should be made by a registered practitioner who is occupationally competent in the task and is accountable in relation to that aspect of the person’s clinical care.“
Peoplehub’s view:
We recognise that the ultimate responsibility for delegation of healthcare tasks sits with the accountable registered practitioner. However, the decision should be a joint decision between the person reliant on the healthcare task (or their representative), the registered practitioner, and the PA. For example, a District Nurse might want to delegate aspects of catheter care to a PA, and the PA may be willing to do this. Ultimately, the person reliant on the healthcare task (or their representative), must have a choice as to whether they are confident and comfortable for the tasks to be delegated.
▣ On page 8, it says:
“A three-way agreement, where all parties (the registered practitioner, the employer and the PA) record that they are happy for the task to be delegated can be helpful. This can also include information about the extent and limits of the delegation, how support will be provided, competency maintained, and when and how to seek help.“
Peoplehub’s view:
A three-way agreement is essential to record everyone’s consent. It should also include information about the extent and limits of the delegation, how support will be provided, competency maintained, and when and how to seek help.
▣ Page 9 of the guidance covers roles and responsibility in delegating healthcare tasks, and says:
“Understanding the responsibility to delegate appropriately and the risks both in not delegating or not delegating appropriately, along with sound protocols, will help practitioners feel confident and support safe and effective practice.”
Peoplehub’s view:
It is undoubtedly important that practitioners feel confident and enable safe and effective practice. It is equally important that both the person reliant on the healthcare task (or their representative), and the PA being delegated to, understand the risks and feel confident and supported.
▣ Page 11 covers the role of the care co-ordinator, and says:
“The person requiring the care or their representative has been consulted as to whether they are happy in principle with the task being delegated to their PA.”
Peoplehub’s view:
Peoplehub feels that the decision to delegate should be a joint decision and conversation rather than a consultation.
▣ The checklist on page 15 of the guidance says:
“Is delegation in the best interests of the person and have they given their consent?“
Peoplehub’s view:
“Best interest” decisions should be primarily held by the person reliant on the healthcare task (or their representative). Principle 1 of the Mental Capacity Act 2005 states that: “A person must be assumed to have capacity unless it is established that he lacks capacity.“
The Mental Capacity Act 2005 Code Of Practice goes on to say that: “The Act’s starting point is to confirm in legislation that it should be assumed that an adult (aged 16 or over) has full legal capacity to make decisions for themselves (the right to autonomy) unless it can be shown that they lack capacity to make a decision for themselves at the time the decision needs to be made. This is known as the presumption of capacity…. People must be given all appropriate help and support to enable them to make their own decisions or to maximise their participation in any decision-making process……. A person should not be assumed to lack the capacity to make a decision just because other people think their decision is unwise. This applies even if family members, friends or healthcare or social care staff are unhappy with a decision.“
Skills for Care, along with the Department for Health and Social Care, has developed some Guiding Principles and Supporting Resources which builds on the NHS England Guidance. These voluntary guiding principles include how to create the right conditions for delegation and highlight the importance of a person-centred approach and putting the person at the heart of decision-making.
December 2023