Principle Activities for Coordination of Healthcare – (including Delegation)

A comprehensive nursing assessment of the person’s physical, emotional, social, and functional needs, as well as their goals and preferences, is essential for developing a personalised health care plan.

The assessment of a person’s health care needs should be undertaken by a nurse or midwife who is competent and professionally accountable for the specific aspects of clinical care being considered.

A nursing/midwifery assessment should:

• Be collaborative, carried out in genuine partnership with the person being assessed and, where appropriate, those who are important to them;
• Be person‑centred, tailored to the individual’s needs, wishes, values, and goals;
• Be holistic, recognising the full context of the person’s life, acknowledging potential areas of conflict, and maintaining a clear focus on desired outcomes;
• As part of this process, risk assessment must explore how any identified risks could influence the outcomes of the proposed health care intervention. This includes understanding the type, nature, and context of the risk, and identifying any mitigating actions taken or required to manage it safely.

Many individuals wish to retain choice and control for themselves or those they care for, even when their preferred decisions may appear risky to others. Nurses and midwives play a crucial role in working in partnership with the person to support informed decision‑making, helping them understand potential consequences while enabling them to take appropriate responsibility for the choices they make.

Related Resources:

Delegated healthcare activities Guiding principles for health and social care in England.

Link: Delegated healthcare activities guiding principles November 2024  provide a foundation for delegated healthcare activities across the regulatory, legislative and governance landscape, aligning with professional codes of practice and national standards.

Effective collaboration requires trust, strong working relationships and a shared sense of purpose with the staff involved (across range of professionals and agencies) and person drawing on care and support (and the people important in their lives. Nurses and midwives play a crucial role in valuing and empowering shared decision‑making, ensuring people are active partners in shaping their health and wellbeing. By recognising individuals as experts in their own lives, nurses help ensure that care decisions are meaningful, personalised, and aligned with what matters most to the person. Shared decision‑making requires nurses and midwives to provide clear, accessible information, support people to understand their options, and ensure decisions about the right care, right person, right time, right place are made together. This includes considering the person’s level of health literacy and supporting them to weigh the benefits, risks, and consequences of different choices.

Effective shared decision‑making brings together:

• Nurses’/midwives’ clinical expertise, evidence, risks, benefits, and treatment options;
• The person’s knowledge of themselves, their goals, preferences, values, and circumstances.

By engaging people in their care planning, nurses and midwives strengthen autonomy, build confidence, and enable individuals and families to play meaningful roles in managing minor conditions, preventing illness, choosing appropriate treatments, and living well with long‑term conditions. Supporting this partnership not only improves outcomes and experiences but also encourages healthier behaviours and a stronger sense of ownership over personal wellbeing. Within the multidisciplinary team, shared values and a unified vision are essential to delivering safe, coordinated and person‑centred care. Nurses and midwives play a key role in fostering this shared approach by promoting open communication, mutual respect and a collective understanding of the person’s goals and priorities. By bringing together the diverse expertise of each team member, nurses and midwives aim to ensure that decision‑making is aligned, responsibilities are clear and care is delivered seamlessly. This collaborative foundation strengthens trust within the team, reduces fragmentation and ensures that everyone works towards the same outcomes.

Benefits of shared decision making: It allows people to discuss and share information. This makes sure people have a good understanding of the benefits, harms and possible outcomes of different options. It empowers people to make decisions about the treatment and care that is right for them at that time. This includes choosing to continue with their current treatment or choosing no treatment at all. It allows people the opportunity to choose to what degree they want to engage in decision making. Some people prefer not to take an active role in making decisions with their healthcare professionals

Related Resources:

NICE provide best practice standards for Shared Decision Making: About shared decision making | NICE

Through delegation referral onwards or professional advice, it is important to clearly defined roles and responsibilities for each member of the care team and the person drawing on care and support (people important to them). This is necessary to ensure everyone understands their part and accountability arrangements.

Decisions made through early interactions between the person who is receiving care and the nurse/midwife can frame much of the subsequent approach to delivery of the health care interventions, including establishing responsibilities. Where a health care need has been identified, the nurse/midwife, must lead on the health care decision making, in partnership with the person receiving care. In establishing responsibility, the nurse/midwife must collaborate where relevant with the social care team/education team (with the most appropriate person who will ensure effective communication across the teams/agencies) involved in the person’s care such as the:

• social worker;
• social care key worker;
• social care practitioner;
• personal assistant;
• classroom assistant/School Principal.

There are a number of activities/approaches that can be adopted by the nurse/midwife following assessment to establish their input and ongoing responsibilities of the wide range of care practitioners/agencies who may be involved in delivery of effective clinical decisions to support the Right Care, Right Person, Right Time, Right Place: in addition to delegating health care, nurses/midwives often make referrals or hand over care to other services/professionals, and provide professional advice and guidance.

Guidance for Nurses/Midwives making Referral or Onwards Allocation

Nurses and midwives frequently signpost or refer people, or those involved in their care, to other professionals or services when additional assessment, expertise, or intervention is required. This ensures that responsibility and accountability for specific elements of care are directed to the professional or service best placed to provide it. Referral occurs when the person’s needs fall outside the nurse/midwife’s responsibility, scope of practice or when more specialised input is necessary. For every referral or allocation onwards, nurses /midwives must ensure the person being referred is supported to understand, (based on the information they have) the following:

• Who is responsible for their overall care/support;
• Why they are being referred and what will happen next;
• When they can expect to see the new professional or service;
• Who to contact if they have questions or concerns.

To enable effective referrals the nurse/midwife should consider the following principles (based on the information available to the nurse/midwife):

• The referring nurse/midwife remains accountable for ensuring the referral is appropriate and that the person receives relevant information;
• The nurse/midwife must communicate clearly with the receiving practitioner or service, providing accurate and relevant information to support safe continuity of care;
• Referrals must be made promptly to avoid unnecessary delays in assessment or treatment;
• Clear arrangements for escalation and feedback should be established and communicated;
• It must be explicitly documented whether the referring nurse/midwife will continue involvement or is withdrawing from further input to the person’s episode of care e.g., discharging their service).

Guidance for Nurses/Midwives giving Professional Advice

Nurses/midwives often provide professional advice within their scope of practice to service users, (and those people important to them), and other professionals/care agencies, which is related to individuals identified health care. Information and advice content should, where possible, be provided in the manner preferred by the person receiving it. The information and advice must also be open to everyone who would benefit from it in agreement with the person receiving the care.

To enable effective advice giving the nurse/midwife should consider the following principles (based on the information available to the nurse/midwife):

• Ensure the advice aligns with the nurses/midwives scope of practice and regulatory codes and guidelines;
• Be open and honest about any potential risks or errors, and work collaboratively to address any issues;
• Ensure there are escalation details/processes to report any concerns;
• Maintain accurate records of the advice provided and any actions taken;
• Actively listen to the person (receiving the advice) concerns and understanding, recognising their unique perspective;
• Avoid jargon and technical terms, enabling the advice to be easily understood by the person receiving the advice;
• Encourage open questions and discussions to ensure the person receiving the advice understands to the best of their ability;
• Consider competency of the person to understand and implement the advice;
• Consider the ongoing support and oversight for the advice being given or whether the nurse/midwife are withdrawing their input to this episode of care;
• Record (where relevant) advice provided;
• The nurse/midwife must consider the most appropriate format for providing information and advice:

• • Face-to-face contact with the person receiving the care;
  • Peer-to-peer contacts;
  • Telephone;
  • Written;
  • Electronic e.g. email.

Implementation of the agreed support plan (including health care interventions) is required to achieve specific health care outcomes, as per agreed timelines and measurable goals, enabling each member of the care team to undertake their area of responsibility.

A shared care plan should be developed following a nursing or midwifery assessment. This assessment must be collaborative, person‑centred, and holistic, focusing on the individual’s needs, goals, and circumstances and preferences. As part of this process, the nurse or midwife must complete a risk assessment, considering the type and context of risks and identifying any required mitigating actions and escalation.

Care planning should be completed with the person and the most relevant health care professional, using best evidence and ensuring consent. It must follow agreed protocols, policies, and regulatory requirements to ensure interventions are delivered safely, competently, and with clear accountability across teams and agencies. When creating the care plan, the responsible health care professional must clarify the intervention details and ongoing review arrangements, taking into account:

• The person’s health needs, complexity, predictability, and expected outcomes;
• Identified risks and steps to mitigate them;
• Who is the most appropriate team member to deliver the intervention, based on competence, confidence, experience, and scope of practice;
• The supervision arrangements: direct or indirect;
• Who will monitor outcomes and who to contact for advice or reassessment, especially when needs fluctuate;
• What the processes are for escalation, in hours and out of hours;
• Implementation and review processes, including roles, responsibilities, and frequency of evaluation.

This aims to ensure a shared care plan that supports safe, person‑centred, and well‑coordinated care across professionals and multi-agency teams.

Partners in Delegation of Health Care Interventions

There are a range of people, staff and agencies that provide a support network and contribute to a shared care plan.  This is list is not exhaustive, however some common parties who work with the nurse/midwife include:

Person in receipt of health care interventions

The person in receipt of the care (and where they chose, those close to them), must be involved in decisions about how their health care needs are met, building on their individual strengths, their goals, what they’re able to do for themselves and what matters to them. It is important that people who draw on care and support, have supported to exercise their choice and control and have the right to decline or withdraw their consent at any stage of the process. It’s also important to consider people’s networks and community connections to promote independence for people’s better health and wellbeing outcomes and quality of life.

Regulated Health Care Professional

Regulated healthcare professionals are responsible for making the clinical decision regarding specific health care interventions, for which they are deem occupationally competent. They must act within their professional scope of practice and their professional and regulatory standards. Examples of regulated healthcare professionals include:

• Nurse/Midwife;
• AHP e.g. occupational therapist, speech and language therapist, Physiotherapist, Podiatrist;
• GP.

(this list is not exhaustive)

Regulated healthcare professionals work as part of the wider team and in partnership with the person who is receiving care to implement shared goals, considering the best interest of the person as part of the care planning process. They are responsible for the clinical decision-making and care planning for health care interventions within their scope of practice and responsibility.

Key Worker

Those receiving health and social care services should have a primary point of contact. The Key Worker is often the person responsible for ensuring completion of the overall assessment of need, linking with other professionals/agencies, developing and co-ordinating the service user’s support plan, for monitoring its progress and for staying in regular contact with the service user and everyone involved.

In relation to healthcare interventions, the Key Worker is responsible for the following:

• Referring to the relevant nurse/midwife (or relevant regulated health care professional) when healthcare needs are identified. In the first instance, this may require a referral to the GP to identify the professional with the relevant occupational competence.
• Where relevant, working in partnership with the nurse/midwife to agree the right person to carry out the health care interventions as part of the support plan: considering the recommendations based on holistic assessment and risk assessment completed by the nurse/midwife.
• For overseeing the implementation of the support plan, working in partnership with the person receiving the care, the nurse/midwife and those carrying out the health care interventions to ensure the identified health care goals are being achieved.
• Escalating information to the nurse/midwife (or relevant health care professional) if the person’s health care needs change or in response to any concerns.
• Collaborating and seeking input from the relevant health care professionals at time of scheduled review.
• Recording and communicating to the wider team, the ongoing support plan and service outcomes.

Support Worker – (for the purpose of the describing roles under partners in co-ordinated care Support Worker is the collective name for social care practitioner, personal assistant (PA), classroom assistant.)

Support workers (social care practitioners, personal assistants employed and classroom assistants) play an essential role in delivering aspects of a person’s health and social care. They are often the person working most closely with the person requiring care and support; they are often able to respond quickly and in a timely manner. They may have developed a very good understanding of the person they care for and have particular skills in communicating with them. Their skills, knowledge and availability may make them ideally placed to carry out many delegated health care interventions or accept advice or referral/allocation onwards. Their responsibilities sit within the wider coordinated care plan and require them to work safely, competently and within agreed boundaries.

Training, Competence and Safety: Support workers must be appropriately trained to carry out any healthcare intervention identified in the support/care plan. They have a responsibility to decline interventions/tasks if they do not feel able to deliver them safely, whether due to insufficient training, environmental challenges, lack of support or supervision or changes in the person’s condition that make the intervention unsafe.

Regulation and Duty of Care: Social Care Practitioners employed by Trusts and Private Care Provider organisations are regulated by the Northern Ireland Social Care Council (NISCC) and must work within the boundaries of their employer’s policies, their training and their assessed competence. They hold a professional duty of care and are accountable for their decisions and actions.

Personal Assistants and Classroom Assistants, while not regulated by NISCC. PAs are directly employed by the person drawing on care and support and Classroom Assistants by the Education Authority. They still hold a duty of care for their actions and omissions and must work safely within the agreed support plan.

Accepting Health Care Interventions: When accepting responsibility for any delegated health care task, the support worker must:

• Follow the person’s care plan and never perform tasks outside their training or competence.
• Undertake required training and confirm competence and confidence before carrying out any health care intervention.
• Seek advice and support from their employer and the relevant health care professional if something is unclear or if concerns arise.
• Refuse or stop carrying out any health care intervention they have not been trained for or that exceeds the limits of the agreed support/care plan.
• Request retraining within appropriate timescales if their competence is due to expire or if updates are required.
• Report any concerns about the intervention or outcomes promptly to their employer and regulated health care professional (or care manager, depending on the governance structure and agreed escalation process).

Health Care Assistant/Midwifery Support Worker

A Health Care Assistant (HCA), Midwifery Support Worker, supports the delivery of safe, effective patient care by carrying out delegated clinical and non‑clinical tasks under the supervision of a registered nurse/midwife, who retains overall accountability. HCAs/Midwifery Support Workers report directly to the registered nurse/midwife.

The nurse/midwife remains professionally accountable for: the decision to delegate, the appropriateness of the task and outcomes resulting from the delegated care

The HCA/midwifery support worker is accountable for their own actions, meaning they must:

• Work within their competence
• Follow instructions and protocols
• Raise concerns or refuse tasks beyond their scope

This differs from social care practitioners/classroom assistants/PAs, who typically work under organisational or managerial accountability rather than direct clinical supervision by the nurse/midwife. An HCA’s/midwifery support worker scope is:

• Defined by their job description
• Limited by their training and competence
• Governed by local policies and protocols

They must not independently assess, diagnose, care plan or make clinical judgments. If an HCA feels an intervention/task is unsafe or outside their competence, they are expected to decline and escalate.

Monitoring of the agreed goals and the outcomes of health care interventions are important, to ensure effective care, achieving the desired outcomes and facilitate adjustments to be made to the care plan in a timely manner.

The nurse or midwife is responsible for determining and clarifying the level of supervision required for any delegated care, whether direct or indirect and agreeing this with the Key Worker overseeing the overall support plan. As part of delegation, the nurse/midwife must also agree and document the monitoring and review plan for the person’s health care intervention and expected outcomes.

Health and care interventions evolve with new evidence and best‑practice standards, therefore it is the nurse/midwife’s responsibility to ensure that the intervention remains aligned with current clinical guidance. Reviews must be person‑centred, actively involving the individual receiving care, their representatives where appropriate and reflect contributions from support workers and/or the key worker. Effective shared care planning requires the whole team to work efficiently and safely, supported by structures embedded within an integrated health and social care system.

The nurse/midwife must clearly outline the monitoring and review arrangements for all agreed goals and health care interventions within the care plan. During care planning, they should confirm whether a scheduled review is required or whether monitoring will occur only when concerns are raised by those delivering the care. Monitoring plans should enable:

• Open communication to maintain safety, continuity, and quality of outcomes;
• Clear arrangements for scheduled monitoring (where appropriate) and clear escalation routes when a person’s needs change, including out‑of‑hours contacts;
• Identification of any additional learning or development needed to support changes in the intervention; and
• Agreement on how often competence will be reassessed for the person carrying out the delegated intervention.