The health and social care system in Northern Ireland is experiencing increasing and changing demands, in response to the needs of people living with chronic conditions, disabilities and multimorbidity. This is evident across the lifespan, where advances in medical technologies have improved health outcomes for people; ranging from premature babies and children with complex medical conditions, through to supporting an increasing ageing population live longer and healthier lives. In response, it is important to organise the delivery of health and social care services that moves away from a fragmented and disease-centred approach to a holistic, patient-centred one (WHO) Transforming health and social services towards a more person-centred and integrated care).
The Minister’s Three-Year Plan, published in December 2024, set out the ambitions for the HSC until the end of the Assembly Mandate (2027). These are based on the three pillars of Stabilisation, Reform and Delivery. The Three-Year Plan provides a strategic direction of travel towards care provided in the community, as close to people’s homes as possible, with admission for care in hospital only when absolutely necessary, with an overarching commitment in doing so to reduce health inequalities. The Reset Plan published in July 2025 provided further detail on actions – link: Health and social care NI Reset Plan
Over the years health‑care delivery models in Northern Ireland (NI) have shifted significantly. A growing number of people now have complex, long‑term health conditions and many of these individuals are supported in their own homes rather than in clinical settings.
As a result, the care they require is both complex and ongoing, often involving health interventions traditionally delivered by registered nurses. Delegation of health interventions, mainly by the registered nurse, is commonplace across Health and Social Care (HSC) Trusts, independent providers and third‑party agencies in NI. When done well, it enables timely, flexible, and person‑centred care, improves continuity and maximises workforce capability by utilising our collective workforce skills efficiently.
This Delegation in Practice a Governance Framework for Nurses and Midwives is designed to support the nurses/midwives to practically apply existing professional guidance within multiprofessional, across multi-agency teams. It also seeks to strengthen partnership working with the person receiving care and support, promoting a risk‑enabled, empowering approach that enhances their choice, control, and involvement in decision‑making.
This Framework for nursing and midwifery delegation will:
- satisfy the requirements of the NMC Code;
- support risk enablement in the delivery of person-centred outcomes for people drawing in receipt of care/support;
- work in primary, secondary and community care contexts;
- support practice delegated to staff working within an employed capacity e.g. domiciliary, support staff, classroom education support staff and Personal Assistants;
- utilise an approach that informs effective and consistent decision making; and;
- support co-ordination of care across professions, teams and agencies in partnership with the person receiving health care interventions.
What is Delegation?
Delegation for the purposes of this framework, is defined as the process by which a nurse or midwife (delegator) allocates clinical or non-clinical tasks and duties to a competent person (delegatee). The delegator remains accountable for the overall management of practice, for example, in a clinical context: the plan of care for a service user, and accountable for the decision to delegate.
The delegator must ensure that the delegatee is confident and competent to carry out the delegated health care interventions. However, the delegator cannot be responsible for the delegatee actions, if they act outside of their scope or guidance regarding the interventions/tasks which have been delegated as part of the healthcare/support plan?
Delegated healthcare interventions/tasks are clinical interventions that would normally be carried out by a registered nurse/midwife, but are formally delegated to a suitably trained and competent person. Examples may include:
- PEG feeding and enteral nutrition;
- Wound care;
- Tracheostomy care;
- Catheter management; and
- Stoma care.
The key word is delegated. These are not simply tasks/interventions that people are trained to do e.g. social care practitioners/classroom assistants/health care assistants. They are healthcare interventions delegated by a nurse/midwife who retains accountability for the outcome. This is a critical distinction.
Employers have responsibility to ensure that their staff are trained and supervised properly until they can demonstrate competence in their roles. Employers accept ‘vicarious liability’ for their employees. This means that, provided the employee is working within their sphere of competence and in connection with their employment, the employer is also accountable for their actions.
Training Is Not Delegation
One of the most common misunderstandings, is confusing training with delegation.
For example:
A product representative from an enteral feeding company provides training on equipment and staff are considered competent. The service assumes delegation has occurred when it has not.
Nurse/Midwifery Health Care delegation requires:
- A named registered nurse/midwife professional;
- A decision that the intervention is appropriate to delegate;
- Assessment of the individual social care staff’s competence;
- Clarity about accountability; and
- Ongoing review arrangements.
Supplier training, even when thorough, does not replace formal nurse/midwife delegation.
Where service commonly do not comply with expected standards:
Across the sector, the following patterns emerge regarding noncompliance with delegation standards:
- No clearly identified delegating nurse/midwife;
- Supplier training assumed to equal delegation;
- Competency sign off completed once and never reviewed;
- Escalation arrangements are informal or unclear;
- Delegated healthcare interventions/tasks are embedded in practice but not formally documented; and
- There is not a formal evaluation/audit of delegation arrangements.
Nursing Midwifery Council (NMC): What the Regulator says about Delegation
Registered nurses have a duty of care and a legal liability with regard to the patient. If they have delegated an activity they must ensure that it has been appropriately delegated.
The Nursing and Midwifery Council (NMC) Code (2015) states in the section entitled ‘Practise effectively’ that registrants must:
Be accountable for your decisions to delegate tasks and duties to other people
To achieve this, you must:
- only delegate tasks and duties that are within the other person’s scope of competence, making sure that they fully understand your instructions;
- make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care, and;
- confirm that the outcome of any task you have delegated to someone else meets the required standard.
NMC also provide supplementation information on delegation: link: delegation-and-accountability-supplementary-information-to-the-nmc-code.pdf
NMC: What does this mean in practice?
If you’re delegating a task, it’s your responsibility to make sure that:
- delegation does not harm the interests of people in your care;
- the task is within the other person’s scope of competence;
- the person you are delegating to understands the boundaries of their own competence;
- the person you are delegating to understands the task;
- the person you are delegating to is clear about the circumstances in which they must refer back to you;
- you take reasonable steps to identify any risks and whether any supervision might be necessary;
- you take reasonable steps to monitor the outcome of the delegated task.
For more information on regulatory standards and guidance see Enablers for delegation of healthcare interventions: Professional standards and regulatory frameworks