Setting up governance
and protocols

Effective governance is essential to a successful DHA programme. Consider how to establish delegation principles, set out policy and protocols, and address matters related to provider insurance and Care Quality Commission (CQC) registration.

Governance should also address safety and the potential for errors, liability, clinical supervision, matters related to training and competence, and workload for providers, care workers and district nurses.  

Having your governance structure in place, that’s crucial, to make sure that your training, and your competencies, and your processes are robust, because you are delegating that task, and that’s where people really get nervous.

Establish clearly specified protocols/standard operating procedures to provide reassurance to stakeholders and be aware that approval of protocols may take considerable time. In one borough, this took a year. Approval may take longer where an NHS Trust covers several local authorities; it appears to be easier where there is a one-to-one relationship between a particular Trust and one local authority. Do then build in time to ensure that protocols can be fully developed and approved.

While the implications of DHA for provider insurance are frequently raised as a concern, in our study, no providers had had to pay additional premiums. Similarly, no change to provider CQC registration was required. In both cases, this was because the activity had been delegated, and the provider did not hold responsibility for it. Reassurance to providers on these matters is important in gaining their engagement with DHA.

It is not the purpose of this toolkit to provide detailed guidance as to the compilation of protocols. However, some notable points that might assist in the development of DHA protocols include:

  • Draw on existing robust and reliable model protocols which can be applied and/or tailored for new DHA programmes. These include a number devised by the NHS, the NMC, SfC and Diabetes UK.
  • Consider using standard templates that can be adapted and populated.
  • Protocols should cover training requirements and competency supervision, sign off and monitoring, and re-accreditation.
  • Topics that can be included are: selection criteria for care workers to participate. Who will conduct training? What will be the training format? How will assessment be carried out? Who will carry out competence supervision of care staff? Who will sign off competence? What will be the timeframe for re-accreditation? 
  • Protocols should also cover ongoing support. For example, the provision of cover for care worker sickness, holiday and importantly, it should be stipulated that district nurses will take back the DHA if required. 
  • It can be useful to write one overarching DHA policy that provides for SOPs to be written for specific activities; this offers flexibility.
  • Record keeping of care worker DHA training and competence for CQC inspections is important.

Robust DHA policy and protocols are essential, and approval processes must account for local structural and cultural factors.