Evaluating DHA programmes
It is essential to undertake formal evaluation in order to understand the impact on the person using services in relation to their health outcomes, quality of life and wellbeing. Evaluation should also be used to monitor:
- Safety: crucially, there should be no detrimental impact on care
- Impact on health and care systems
- Impact on provider organisations
- Impact on district nurses
- Impact on care workers
Evaluation should be an integral part of the delegation process and considered from the outset of a DHA programme. Data gathered from evaluation will also be helpful in the ongoing construction of business cases to further develop DHA.
Key questions to ask regarding evaluation are: when it will be conducted; how frequently; how will it be done; what data will be required; who will be involved in evaluation activities. With regard to the latter, evaluation may be on a small scale or may involve support from wider partners such as local universities and research organisations.
Using the evaluation provided will support in ensuring robust understanding of the effectiveness of DHA programmes. In the table below, we set out potential outcomes from DHA programmes, how these could be measured and where data to do this may be sourced. While you may not use all of these, do consider carefully at the outset what the DHA should achieve and how this will be evaluated.

Evaluation measures
| Stakeholder | Outcome | How to measure | Data sources |
| District nurses | Increasing scale and scope of DHA i.e. more activities being delegated. Measuring expansion of numbers and range of activities over time is important in evaluating success of the programme. If the numbers decline and there are a significant number of ‘returns’ to DN care, this can be problematic. DN time savings Greater DN caseload complexity Improved DN morale (alleviation of workload pressures on focus on more complex cases) Improved DN recruitment and retention for district nursing. | • Number of people who draw on services receiving DHA • Number of participating care homes • Number of activities that are delegated • Number of people who draw on services receiving DHAs returned to DN team • DN hours saved via DHA • Scored visit complexity • Increased job satisfaction • Lower sickness/absence rates • Reduced turnover/higher retention | • District nurse teams collect this data (or DHA programme leader if in place) • DN/DHA programme lead data/ calculations. E.g. saving of 15 mins per delegated insulin administration per person. Costed at appropriate hourly rate. • The Safer Staffing Tool (NHS England and NICE tool) • ICBs may gather community workforce data • Annual staff attitude surveys • Exit interview data (HR) • Trust data on DN absence rates. |
| People who draw on services | Improved quality of care | • Improved continuity of care • Lowered service user anxiety and fewer refusals • More timely administration of insulin More stable blood sugars • Reduction in medication errors/adverse incidents | • Feedback from people who draw on services and their carers • Fewer refusals captured via DN monitoring and care provider records • More timely administration – captured by DN monitoring systems eg System 1 and EMIS • HbA1C three-monthly monitoring by GPs/DHA prescribers as well as daily blood sugar levels • DN Datex system for medication errors |
| Care Providers | Improved quality of care delivered and improved satisfaction of people who draw on services More skilled workforce Improved recruitment and retention Improved attendance | • Metrics as above for people who draw on services satisfaction • Improved CQC ratings • Reductions in safeguarding referrals • Numbers of staff undertaking training and competence development for DHA • Reduced turnover rate over time and also in comparison to regional and national rates • Time taken to fill vacancies • Reduced sickness absence • Reduced reliance on agency/ bank staff | • As above • CQC data • Provider collected data • DHA trainer records • Provider / SfC ASC-WDS/ICB data • Provider data • Provider / SfC ASC-WDS/ICB data |
| Care Workers | Pay progression Career progression Improved job satisfaction | Pay rates above NLW/RLW Numbers of care workers moving to enhanced care worker role Staff attitude surveys | Provider / SfC ASC-WDS/ICB data Provider/ SfC ASC-WDS/ICB data Provider data |
