Following on from our recent Advanced Practice article on the principles of delegation and accountability {Practice Nurse, July 2015) we look at the practical implications of delegating to healthcare assistants, and when this is or might not be appropriate
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Healthcare assistants (HCAs) are a vital part of the primary care nursing workforce and now provide a great proportion of hands-on care within general practice. Appropriate delegation to HCAs — health care support workers, assistant practitioners and healthcare assistants — is essential in maintaining patient safety and public protection.
However, it is important that practice nurses and other members of the primary health care reach an informed decision before delegating particular activities.
Background
In the wake of recent reports, including the Francis inquiry1 into failings in Mid-Staffordshire NHS Foundation Trusts, and reports of failings in other hospitals and care homes, there has been a focus on ensuring that unregistered staff in the NHS and social care provide safe and quality care.
The Cavendish Report2 and the Shape of Caring Review3 both highlighted the importance of developing the role of the HCA and viewing them as a strategic resource in building the workforce for the future.
The context for health care and support is also changing. Recent NHS publications such as the Five Year Forward View4 focus on the importance of prevention and the shift of services from the hospital to primary and community settings, achieved by the development of new models of care, as the key to ensuring that the NHS is fit for the 21st century. This has meant that new roles and responsibilities have been developed and nurses and care staff work in multidisciplinary teams, where individuals have specific tasks and responsibilities, but increasingly they work together as a team to support and care for patients.
The National Nursing strategy5 also sets out the shared purpose as nurses, midwives and care staff to deliver high quality, compassionate care, and builds on the enduring values and behaviours, which patients, the public and staff should and will expect.
Delegation of nursing activities must take place in the best interest of the patient and the decision to delegate an aspect of care to the HCA must be based on the assessment of the patient’s needs and must not compromise patient safety.
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