Health and social care in Northern Ireland is facing growing demand as more people live longer with complex, long-term conditions and disabilities. In response, services are increasingly focused on delivering integrated, person-centred care closer to home, reducing reliance on hospital-based care where appropriate. Transforming Health and Social Services Towards a More Person-centred and Integrated Care (WHO, 2026) and Health and Social Care NI Reset Plan (DoH, 2025).
As care needs become more complex, delegation of healthcare interventions has become an established part of service delivery across Health and Social Care Trusts, independent providers and third-sector organisations. Effective delegation supports timely, flexible and person-centred care while making best use of workforce skills and expertise.
The Delegation in Practice Governance Framework for Nurses and Midwives provides practical guidance for applying professional standards across multidisciplinary and multi-agency settings. It promotes partnership working, enabling people receiving care to have greater choice, control and involvement in decisions about their care.
The Framework for nurses and midwives supports:
- compliance with the NMC Code;
- safe, risk-enabled, person-centred care;
- delegation across primary, secondary and community care settings;
- consistent and effective decision-making;
- collaborative working across professions, teams and agencies; and
- partnership with people receiving care and support.
What is Delegation?
For the purposes of this framework, delegation is the process by which a nurse or midwife assigns a clinical or non-clinical task/intervention to a competent person. The nurse or midwife remains accountable for the decision to delegate and for the overall management of the person’s care and outcomes.
Before delegating, the nurse or midwife must be satisfied that the individual has the knowledge, skills and competence to carry out the task safely. The individual undertaking the delegated task/intervention remains accountable for their own actions and must work within their agreed scope of practice.
Delegated healthcare interventions are tasks/interventions that would normally be undertaken by a registered nurse or midwife but have been formally delegated to a trained and competent person. Examples include individualised care for PEG feeding, wound care, tracheostomy care, catheter management and stoma care (this list is not exhaustive). The key word is delegated. These are not simply tasks/interventions that people are trained to do and expected to carry out within their scope of responsibility/job plan e.g. social care practitioners/classroom assistants/health care assistants. They are healthcare interventions where the delegating nurse/midwife retains accountability for the outcome. This is a critical distinction.
Training Is Not Delegation
Training alone does not constitute delegation. Formal delegation requires:
- a named registered nurse or midwife;
- a decision that delegation is appropriate;
- assessment of the individual’s competence;
- clear accountability arrangements; and
- ongoing review and oversight.
Even where training has been provided by an equipment supplier or other organisation, formal delegation by a nurse or midwife is still required.
Employer Responsibilities
Employers are responsible for ensuring staff are appropriately trained, supervised and competent in their roles. They also hold vicarious liability for employees acting within the scope of their employment and competence.
Common Areas of Non-Compliance
Common issues include:
- no identified delegating nurse or midwife;
- assuming training is equivalent to delegation;
- competency assessments not being reviewed;
- unclear escalation arrangements;
- poor documentation of delegated tasks; and
- limited monitoring or audit of delegation arrangements.
Key message: Delegation is a formal professional process, not simply training someone to perform a task.
Nursing Midwifery Council (NMC): What the Regulator says about Delegation
The Nursing and Midwifery Council (NMC) states that registered nurses and midwives remain accountable for decisions to delegate and must ensure delegation is carried out safely and appropriately.
The NMC Code (2018) requires registrants to:
- delegate only to individuals who are competent to undertake the task;
- ensure appropriate supervision and support; and
- confirm that the required standard of care is achieved.
In Practice when delegating, nurses and midwives must ensure that:
- the task is safe and appropriate to delegate;
- the individual has the necessary competence and understands the task;
- clear limits, responsibilities and escalation arrangements are in place;
- any risks are identified and managed; and
- outcomes are monitored and reviewed.
Key message: Nurses and midwives are accountable for the decision to delegate and must ensure delegated care is delivered safely, competently and to the required standard.