Evaluating DHA programmes

  • 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

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.

Evaluation measures

StakeholderOutcomeHow 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 servicesImproved 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 WorkersPay 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

Delegated healthcare activities