Deciding who
will take part in DHA

It is important to have clear selection criteria for participation in DHA. In GM, these were developed for each stakeholder group, namely adult social care providers, care workers and people who use services.

Providers should have:

  • A reputation for good, effective and safe care (CQC ratings could also be used here).
  • Robust leadership and management 
  • A stable staff base with low turnover and low use of agency staff.
  • No existing safeguarding concerns
  • Good and open relationships with the district nursing team

Were stable, they wanted to take that step. They were really eager to do it. So, they deliver actually nine injections to four service users a day within that home… [Provider] is part of a wider service provider, and I have spoken to the area manager previously, because actually, their insurance would cover their other care homes, which would open up three other care homes to me. And I think her reluctance with it is that those homes have higher turnover of staff, and she doesn’t feel like they’re a stable enough home to be able to take on more responsibility currently.

Care workers should be:

  • Confident and willing to be involved; no care worker should feel pressured into taking on DHAs and must be able to hand them back at any point, should they no longer want to take part

It was ‘no’ from the beginning [for one senior care worker], it’s been ‘no’ throughout. That’s fine, because it is voluntary. I can’t force anybody to do this task, and I wouldn’t want to, because it’s a big responsibility

  • Preferably trained in medicine management, which may mean restricting it to senior care workers rather than care workers

I do have some care workers that do it, but they have to have their NVQ Level 3 and their meds management. Generally, it’s seniors… 

People using services:

  • Their condition makes them suitable for involvement e.g. for insulin administration, diabetes is Type 2 and stable
  • They are willing to be involved, as this is again voluntary 

Currently, DHA are (largely) voluntary for all parties which is an important consideration in developing programmes and building engagement. For policy makers, this is also an important point for reflection. The proposed National Care Service includes DHA which may suggest their wider roll out. If they are, at some stage, to become compulsory, the resourcing issues noted earlier will require close attention. Also important will be how to engage enough care providers and workers who meet the specified criteria to support desired roll out.