King's College London

Background

Delegated healthcare activities are clinical tasks normally done by regulated healthcare professionals but instead delegated to paid care workers. This study focuses on care homes, where delegation has become increasingly important.

Delegation can improve care through more timely and personalised support, making better use of staff skills, and save time and money.

In practice, the multiplicity of protocols and guidance, across professions, health and social care organisations and regions – leads to variations in practice, regulation, training and accountability.

Previous studies exist but there is a need for more robust research to understand how delegation works and how safety and efficiency can be achieved.

This study will address:

• the drivers of, and the scale of delegation in care homes
• governance
• the impact of delegation on care workers, employers, managers, commissioners, regulators and clients

Methods

This is a two-year study (2026–2028), with a qualitative focus on real-world practice.

• A review of pertinent national and international literature.
• Interviews to establish the policy and regulatory context with key stakeholders, including policy makers, regulators (e.g. Care Quality Commission), professional associations, insurers, and commissioners.
• Case-studies in six care homes (three residential, three nursing), selected to reflect a range of sizes, organisational structures, and locations.

Each case-study will include:

• A review of job descriptions, organisational policies, and CQC inspection reports
• Interviews with care home managers (x 10)
• Interviews/focus groups with registered/unregistered care home staff
• Interviews/focus groups with local system stakeholders: GPs, district nurses, and clinical and care commissioners.

The study will achieve a detailed understanding of how delegation works in the care home sector.

Timetable

April 2026 - April 2028

Funding

NIHR Policy Research Programme NIHR206121(16)

Policy relevance and dissemination

This study will provide evidence to inform policy decisions about delegation in care homes and national discussions about implementing the 10-year plan, workforce development and integration of health and social care services.

Results will be shared via Department of Health and Social Care, academic publications, conferences, and engagement with stakeholders and public contributors.