A SYSTEM APPROACH TO UPSKILLING AND SAFE DELEGATED HEALTHCARE

 

What we did

In 2024, NHS Coventry and Warwickshire ICB carried out a series of deep‑dive conversations with health and care employers to understand where system‑wide education and skills development could make the greatest impact.

Across the area, employers reported that while they could recruit support workers, retaining them was much more challenging. This was reflected in the Adult Social Care Workforce Data Set (ASC‑WDS) 2023–24, which showed a 30.5% turnover rate for support workers locally. The data also highlighted pay inequities and that only a small proportion of support workers held a social‑care‑related qualification.

The ICB began exploring how Delegated Healthcare Activities (DHA) could help upskill the support workforce—improving retention, boosting recruitment, and enhancing the quality of care. This became increasingly important in 2025 when Fit For The Future: 10‑Year Health Plan for England emphasised a major shift from hospital‑based to community‑based care. The ICB sees DHA as a key enabler of this shift and an essential component of developing integrated neighbourhoods.

A scoping exercise identified a mix of informal delegation across the system, alongside one large, well‑established formal DHA programme developed by South Warwickshire University NHS Foundation Trust (SWFT).

 

Buiding the approach 

In June 2025, a multi-agency workshop brought together more than 30 stakeholders from across health, social care, education and the voluntary sector to explore how Delegated Healthcare Activities (DHA) could be developed locally. The session examined where DHA could add the most value, the barriers and enablers to implementation, and what would be needed to ensure it was safe, effective and worthwhile.

Participants identified a range of areas where DHA could support care delivery, including medication administration, respiratory care, insulin management, rehabilitation, wound and catheter care, and other complex care tasks.

Building on this momentum, a second event in September 2025—part of the Skills for Care national DHA roadshow—brought together 65 participants from across the Midlands to share learning from pilots and consider the next steps for Coventry and Warwickshire.

Following the event, a multi-partner DHA working group was established in October 2025. Made up of care providers, NHS Trusts, commissioners, local authorities, academic partners, and quality and education leads, the group meets monthly to co-design a practical system-wide blueprint to support safe and consistent delegation. The blueprint is being developed around 12 key “building blocks”, covering areas such as governance, training and competence, legal considerations, documentation, and quality assurance.

What’s next

Once the DHA blueprint has been drafted, it will be shared for consultation with a group of “critical friends.” This group was identified during the second workshop and includes people who are interested in DHA but could not commit to joining the working group—further evidence of the widespread enthusiasm across the system.

Following consultation, feedback will be used to refine the 12 building blocks that underpin the blueprint. The final version will then be piloted across a range of settings to test whether it adds value, supports safe delegation, and strengthens quality of care.

Pilot sites are currently being identified, with discussions underway with Unique Care UK. NHS Hereford and Worcestershire ICB has also joined with NHS Coventry and Warwickshire ICB and is keen to pilot and further shape the blueprint.

Each pilot will report against a set of key performance indicators, assessing:

1. Quality and safety of delegated care
2. The experience of people receiving DHA
3. The strength of governance arrangements

Once piloted and reviewed, the final blueprint will be published on the Coventry and Warwickshire webpage, supported by a communications strategy. Publication is planned for March 2027.

You can read more here.