Delegated healthcare activities: how to delegate safely in social care

Insulin injections. PEG feeds. Stoma care. Catheter care. Tasks once done only by nurses are now part of everyday work for many care workers. Skills for Care's 2026 workforce report shows non-nursing staff carrying out delegated healthcare activities in 59% of the CQC-regulated services that answered the question. It is the first time the report has measured it, and the number tells us delegation is now mainstream.

Done well, delegation is good for people. It means fewer missed visits, less waiting for a district nurse and more choice and control over care. Done badly, it puts both the person and the care worker at risk.

What is a delegated healthcare activity?

It is a healthcare task that a regulated healthcare professional, such as a nurse, occupational therapist or speech and language therapist, passes to a paid care worker. Common examples include:

• supporting a person to give their insulin
• assisting with PEG feeding
• basic stoma care
• urinary catheter care
• simple wound care

Skills for Care and the Department of Health and Social Care published guiding principles in 2023 to support safe delegation. They are voluntary, person-centred and designed to fit local protocols.

Who is responsible for what?

Safe delegation depends on everyone knowing their part. In my experience, problems arise when these lines blur.

Five principles of safe delegation

1. Person-specific. A delegation is for one named person, not "all residents with diabetes". Competence with Mr Jones's PEG does not cover Mrs Ahmed's.
2. Trained and assessed. A care worker must be trained and signed off as competent before working alone.
3. The right to say no. A care worker who does not feel competent or confident should say so, and must be supported, not pressured.
4. Clear records. Every task, observation and concern goes in the record. If it is not written down, there is no evidence it was done safely.
5. Regular review. Competence and the person's needs change, so delegations should be reviewed rather than left to run indefinitely.

The training gap

Here is the tension. Delegation is rising, but only 37% of care and support workers hold a Level 2 qualification or above. We are asking staff to do more clinical work with less formal grounding than five years ago.

That makes underpinning knowledge essential. A care worker giving insulin should understand hypoglycaemia, not just how to use a pen. A worker managing a catheter should recognise the signs of infection. Task training teaches the how; good education teaches the why.

A role recognised at last

The Care Workforce Pathway now includes an enhanced care worker role for staff who carry out delegated healthcare tasks or give condition-specific support. That is welcome recognition. Employers should use it to build a clear route for staff who take on clinical responsibility, and reflect it in pay and progression.