Delegated Authority for Clinical Governance and Delegated Healthcare in Adult Social Care
Delegated healthcare and clinical governance are areas where unclear authority quickly becomes unsafe. Providers need a clear, auditable scheme so managers know what they can decide, what must be escalated, and how clinical risks are assured. A robust delegated authority and scheme of delegation supports safe decision-making and accountability, aligned with effective governance and leadership.
This article explains how delegation should operate for clinical governance, delegated healthcare tasks and medicines-related risk in UK adult social care, including day-to-day practice and defensible assurance.
Why clinical delegation needs explicit controls
Many providers deliver elements of health support in social care settings: medicines support, catheter care, PEG feeds, insulin prompts, oxygen safety, pressure care and escalation to community teams. Risks arise when:
- Frontline decisions are made without defined clinical oversight
- Managers authorise tasks outside competence frameworks
- Escalation is inconsistent between services or shifts
- Incidents are managed operationally but not clinically reviewed
What the scheme of delegation should cover
For clinical governance and delegated healthcare, the scheme should define:
- Authority to approve delegated healthcare delivery (who signs off pathways and task lists)
- Competence and training requirements (who confirms staff are competent and when reassessment is needed)
- Clinical escalation triggers (when to contact GP, district nursing, 111/999, or safeguarding)
- Medicines and health-risk thresholds (e.g. repeated omissions, PRN use patterns, controlled drugs discrepancies)
- Clinical incident review arrangements (who leads review and how learning is implemented)
Operational example 1: Delegated catheter care with competence sign-off
Context: A person supported at home requires catheter care and monitoring to reduce infection risk. District nursing delegates aspects of care to trained staff.
Support approach: The scheme of delegation clarifies that only an authorised clinical lead (or delegated nurse assessor where in place) can approve the delegated task pathway for that individual, and that the registered manager can only deploy staff who are signed off as competent.
Day-to-day delivery detail: Staff complete catheter care training and supervised practice. Competence is recorded on a task-specific competency checklist. The manager checks competence status before rostering. Any signs of infection (temperature, confusion, discomfort, urine changes) trigger immediate escalation under a defined pathway, including timeframes and who to contact.
How effectiveness or change is evidenced: Spot checks confirm correct technique and documentation. Incident logs show timely escalation and reduced infection-related unplanned contacts over time, supported by audit of catheter care records.
Operational example 2: Medicines risk escalation and review for repeated omissions
Context: A supported living service identifies repeated medicines omissions due to refusal and inconsistent staff approach.
Support approach: The scheme defines that site managers can implement immediate risk controls (extra prompts, MAR re-check process, handover emphasis), but repeated omissions above a defined threshold must be escalated for a medicines governance review led by a competent medicines lead.
Day-to-day delivery detail: Staff record refusals consistently, with capacity considerations and best-interest actions where relevant. The manager triggers a medicines review meeting involving prescriber/pharmacy where needed, updates the risk assessment, and ensures staff guidance is consistent. Training is refreshed and a short-term audit cycle is introduced.
How effectiveness or change is evidenced: MAR audits show reduced omissions and improved documentation quality. The service evidences learning through action logs, refreshed guidance and supervision records.
Operational example 3: Delegated pressure care tasks and escalation for skin breakdown
Context: A person with reduced mobility needs pressure area monitoring and repositioning support, with a history of skin breakdown.
Support approach: The scheme clarifies that only staff with verified competence can deliver pressure care tasks, and sets escalation triggers for skin integrity concerns that require clinical input.
Day-to-day delivery detail: Staff complete repositioning according to the care plan, record turns and skin checks, and use equipment correctly. Any redness, broken skin, or pain triggers immediate escalation to the responsible clinician and internal clinical lead, alongside review of equipment and support frequency. The manager ensures an immediate care plan update and verifies implementation through spot checks.
How effectiveness or change is evidenced: Quality monitoring records show compliance with turning schedules, reduction in skin breakdown incidents, and evidence of timely clinical engagement when concerns arise.
Commissioner expectation
Commissioner expectation: Commissioners expect providers to safely manage delegated healthcare within agreed pathways, demonstrating trained and competent staff, clear escalation, and reliable audit trails for medicines and clinical risk. Where healthcare risks increase, commissioners expect early notification and evidence of effective risk management.
Regulator / Inspector expectation
Regulator / Inspector expectation (CQC): CQC expects governance systems to keep people safe where health tasks are delivered in social care. Inspectors look for clear accountability, competence assurance, robust medicines management, effective learning from incidents, and leadership oversight that prevents avoidable harm.
Assurance mechanisms that make clinical delegation defensible
Providers typically evidence safe clinical delegation through:
- Competency frameworks and reassessment schedules
- Medicines audits (including PRN review and omission analysis)
- Incident review with clinical input where relevant
- Escalation pathway testing (e.g. scenario checks in supervision)
- Board or senior-level reporting on health-related risk themes
Delegated healthcare can be delivered safely in adult social care, but only where authority, competence and escalation are explicitly controlled and routinely assured.