Deciding what
activities to delegate
Consider which activities can be delegated and why? In GM, there was not a prescribed list of activities, and each borough determined its delegation priorities which broadly emphasised the ‘living well’ ethos and, more specifically, activities which a family or friend might support with:
It was about things that were caring tasks that you would do for a family member or a friend as part of your everyday…. And then, the conversations were looking at, ‘Well, what are the kinds of things that district nurses are doing that might be taking up their time, but actually, it’s a task that a care worker could do?’
Choice of DHA may vary by local authority, dependent on the differing needs of people who use services, scale of demand and care worker skills and confidence. DHA might also vary across geographies, so identifying need and what offers the biggest return
is important. Consider undertaking a scoping review of district nurse caseloads and the needs of people who draw on services
can help determine priorities.
[DNs] were really struggling, we did a scoping piece of work on, ‘What are we going to see all these patients for?’ And one of the biggest demands was insulin. So, in one day, [DNs] could’ve had up to 170 insulin injections. They’re timed visits, so they can be all grouped together at 8:00 AM, before breakfast. So, as one nurse, I could be allocated eight visits, and all eight of them need to have it before breakfast. Well, that’s impossible.
In our study, the main focus was delegation of insulin administration given identified district nurse time savings. Another borough had, however, undertaken an analysis that indicated that there was a relatively limited need for insulin delegation and that wound care was a bigger priority. It had then decided to focus its resources on that delegated activity. Each locality will need to use its own data to determine priorities. It is advisable to begin with small-scale pilot schemes that offer valuable insight and learning before scaling up delegation more widely.
It is also important to consider whether delegation will take place across all types of adult social care provision. In GM, the bulk of delegation was in residential care, but we found that it was extremely powerful, if more challenging to deliver, in homecare. Implementation in both sectors is central to maximising its benefits so consider how and whether to roll out in both residential
and homecare.
Implementing DHA programmes: checklist
