Covid-19 highlights issues surrounding delegation of nursing care tasks to home care workers

Within the social care sector, certain tasks are generally seen as tasks that can only be undertaken by nurses.  Examples of this might include administering injections or administration of mediation via feeding tubes.  Prior to the current Covid-19 crisis, the CQC’s guidance (based on NICE guidelines in 2017) stated that in certain circumstances nursing tasks could be delegated to care home staff.  This would be subject to the nursing staff/healthcare professionals being satisfied the care worker was satisfactorily trained and competent to undertake the task.  The healthcare professional would remain responsible for ensuring that the care worker was undertaking the task correctly.  The CQC’s previous guidance stated that care home providers should have policies in place to cover this possibility and that the care workers should be properly trained in the task they were being asked to undertake.

The CQC has now updated its guidance on this issue as at 1 April 2020 in view of the strain on healthcare professionals like district nurses from Covid-19 and in view of new guidance from the Nursing and Midwifery Council. The CQC’s updated guidance reiterates various points including that the care worker ought to know their own limitations and when to seek help/assistance.  The new guidance also emphasises that if a care worker accepts responsibility for undertaking tasks then they have responsibility for doing so in line with instructions and as part of a detailed care plan.

At present healthcare professionals and care homes/domiciliary care bodies are under severe strain due to the Covid-19 virus and it is easy to see how the normal way of working may be disrupted due to staff shortages or lack of resources.  In the social care sphere however it is important to ensure any delegation of traditional nursing tasks to care workers is undertaken properly and within the correct parameters set out by bodies such as the CQC and the NMC.  From the claims perspective, the present guidance places responsibility on healthcare professionals to ensure the tasks are delegated properly to care workers, but then also places responsibility upon care workers to ensure they carry these delegated nursing tasks in line with care plans.  Any claim arising from this scenario would need to be carefully examined in order to see whether the task was properly delegated in the first place but also whether the care worker followed the instructions and care plan properly.

If any claim did arise from this, any policy conditions would require careful consideration.

A copy of the CQC’s updated guidance can be found here.


Jennifer Johnston, Associate, BLM

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