Delegated healthcare tasks: challenges and opportunities ahead in adult social care

Analysing the part that insurance can play

A move towards delegated healthcare tasks in the adult care sector is gaining pace, creating opportunity but also driving complexities, challenges and increased risks for care providers and care home owners.

A Department of Health & Social Care (DHSC) blog confirmed the direction of travel back in 2024, saying: "Delegation of healthcare activities is happening across adult social care and has been for many years."

Now the pace of change is accelerating, mirroring the NHS strategy to move some healthcare provision away from GPs and hospitals to other providers such as pharmacies.

The public has already become used to visiting a pharmacy for services such as vaccine injections or blood pressure tests; but the delegated healthcare tasks for professionals in adult health care, and especially in care homes, come with a heavier responsibility.

The administering of daily medicines is already a major part of care provision in care homes but new provisions can include:

• Administering insulin for individuals with diabetes.
• Catheter and stoma care, including changing stoma bags.
• Percutaneous Endoscopic Gastrostomy (PEG) feeding.
• Wound dressings and pressure area care.
• Oxygen monitoring.
• Supporting with a crisis plan for mental health.

At present, the model doesn’t include a capacity to prescribe medicine for those in care. However, the direction of travel is clear.

The DHSC has recently made £461,000 available for the Adult Social Care (ASC) Nurse Prescribing Pilot – to fund nurses across the country to undertake a Nursing and Midwifery Council approved prescribing qualifications. This will qualify them to prescribe medicines within their ASC setting and provide nurses with credits towards the advanced practice Masters.

Positives arising from delegated healthcare tasks

The move to delegated healthcare tasks has the power to support individuals to live in their preferred choice of home for longer, with more of their needs met by carers there. In-house healthcare services can give relatives of those in care greater confidence that the basic healthcare needs of their loved ones are in safe hands. In an industry where care workers are often under-valued, it provides an opportunity for them to raise their profile through training and development.

The DHSC has now developed a set of voluntary guiding principles for the sector, under the headline titles of:

• Person-centred care
• Governance, regulation and accountability
• Learning development, skills and competency
• Monitoring review

Analysing challenges arising from delegated health tasks

Expectations from the DHSC are high and will require significant investment in training and upskilling at a time when money is short and in which recruitment has become increasingly problematic.

When you add in a rising demand for social care from an ageing population, mirrored by rising costs (across a wide spectrum that includes food and energy bills) then it’s clear there are no easy answers.

We should also include the impact of successive budgets that have driven up the national living wage (NLW) by 6.7% and then 4.1% to a new total of £12.71 per hour from April 2026. The NLW for 18-20-year-olds has also risen to £10.85 per hour.

In addition, the employers' National Insurance contributions secondary threshold is being held at £5,000 until 2031.

Sally Gainsbury, Senior Policy Analyst at the Nuffield Trust, said in November 2025: “The Budget has boosted the National Living Wage - which will come as welcome news to the many social care workers on low wages - but there’s no new money to help the care sector with the impact,

“The impact of last year’s Budget measures, including employers' National Insurance rises, are beginning to bite. Ultimately, people who need care and support will feel the effects as cost pressures continue to increase.”

There is no doubt hat training will be to take the industry forward. The DHSC guidance requires care workers delivering delegated healthcare to:

• Be adequately trained, assessed as competent and properly supervised to carry out the specific task’
• Have a good understanding of clinical terminology and health-related documentation and apply it to care delivery
• Know their own limitations in the use of clinical equipment, seeking help where required, and use and dispose of any equipment safely
• Understand and apply approaches to care and support for people at risk of distress.

In addition, the Care Quality Commission (CQC) expects that delegated care meets regulatory standards and is delivered safely.

Documentation, including a care plan that clearly outlines the delegated tasks, risk management, and contingency arrangements is seen as crucial.

There is some help on the horizon when it comes to recruitment, The government has announced plans to provide guaranteed work placements for 18-21-year-olds who have been out of work or education for longer than 18 months, with social care include on the list of roles to be offered.

A further update in December 2025 said it would fund 350,000 training and work experience placements and guarantee 55,000 jobs in areas that have the highest need (including social care) from April 2026.

Insurance implications

It is not possible for the adult care sector to fully embrace delegated healthcare tasks without also considering insurance implications; after all, these tasks add inherent risks into the business model. So, it is vital that care providers have an open dialogue with their broker to ensure new services are fully covered. Many care homes may not even realise that services already being adopted are not covered under their current policy and as new delegated healthcare tasks are added it is inevitable that insurance requirements will evolve, often requiring extra cover. Examples include:

• Medication management without increased liability exposure
• Mental health services without adequate risk assessments
• Clinical procedures without properly trained or qualified staff
• Rehabilitation services without notifying insurer

Real life example:

Delegated healthcare task: A care home provider has been asked by the District Nurse to discuss the client’s Senior Care Assistants in administering insulin.

This is termed as ‘invasive care (medical procedures that access the body through an incision, puncture or natural orifice to perform a diagnosis or treatment). So, this example could also include catheters, colostomy bags and tracheostomy care.

Additional risk factor: More liability on the client in terms of treatment negligence

Additional insurance risk factor: Policy not providing adequate coverage (some insurers will exclude injections/insertion of the skin & risk of not declaring these additional activities under the insurance act (duty of disclosure)

Additional actions the care provider needs to take:

• Ensure the broker is aware of these additional activities which may not be traditionally performed by care staff
• Make sure care plans are updated
• Make sure training is recorded and signed by care staff

 What you need to do – and what to tell your broker:

1. Advise them of any additional delegated tasks you are asked to take on by Local Authorities, General Practitioners or District Nurses.
2. Make sure these activities are adequately covered
3. Ensure risk assessments are up to date and care plans are adjusted to include these additional tasks
4. Ensure that any additional training requirements are recorded and signed by employees which will in turn assist with any claims defensibility.

Howden is working with government, and with partners within the care sector, to shape plans on how to deal with evolving needs around delegated healthcare.

We understand the impact will be different for all types of care providers, and that a bespoke solution is important to you. Our boutique service means that we can provide solutions to meet all the challenges you may face.