Adults who are eligible for NHS Continuing Healthcare and children in receipt of continuing care have had a right to have a personal health budget since October 2014. From April 2015 clinical commissioning groups (CCGs) have been looking at expanding their local personal health budget offer to others who could benefit. For many people with personal health budgets, employing a personal assistant (PA) or a team of personal assistants is a central part of creating care and support arrangements that are personalised and responsive to their individual needs and circumstances.
Delegation of clinical tasks to PAs
When a PA is providing care and support to someone with health care needs, an important component of their role can include carrying out tasks that are of a clinical nature. These tasks must be considered in the care planning process and be delegated to the PA by a practitioner who has the relevant occupational competence. They must only be delegated when it is in the best interests of the person concerned.
Tasks might include, for example, caring for wounds, catheter or tracheostomy care, managing ventilation or the administration of medicines. The health care practitioner with the relevant occupational competence to delegate the task needs to ensure that there has been a robust risk and benefit assessment completed around the proposed delegation; including an assessment of the stability of the person, the complexity of the task being delegated, and the expected outcome of the delegation. They will then need to provide or arrange for the provision of task specific training and assessment of competence. NHS organisations need to establish their own local protocols in relation to delegation and the best way to train and assess personal assistants to carry out a particular task for an individual.
Training and assessing the competence of PAs
Skills for Health have been working with NHS England to explore approaches to provision of training and assessment of competence in relation to delegated healthcare tasks. This has resulted in a number of reports and practical examples that others may learn from and adapt in establishing their own local systems.
2013 Phase 1 – identifying tasks and units
In 2013 Skills for Health worked with NHS England on the first of what was to become a three phased project. In the first instance they produced a report that identified which healthcare tasks were most commonly being considered for delegation to personal assistants. They found that many of the tasks were within (the then ‘QCF’) units which make up the occupational diplomas and apprenticeships already widely used by the health sector.
2014/15 Phase 2 – testing how units could be used
A further phase arose in response to the initial report. The project wanted to look more closely at how applicable the QCF units would be for organisations to use as a means of training and assessing the competence of personal assistants carrying out delegated healthcare tasks.
A series of demonstrator sites were set up. They looked at the units in detail and selected the delegated healthcare tasks they would like to focus on. Most worked with training providers, registered staff and budget holders to put on training to first upskill and then assess the personal assistants.
Each site had a very different experience. Their approaches training and assessment varied. Some favoured group training, others preferred a completely individualised approach. One found that their own existing system, if refreshed, would be a better fit rather than introducing the units. Some liked the units and managed to achieve economies of scale whilst others struggled with low numbers and high costs, concluding at the close of the project that development of a local tailored solution was required.
2015/16 Phase 3 – developing a repository of information
At the outset of the next phase three of the original sites continued and a new one joined. This time the project was much more flexible, each site making an individual agreement with NHS England about the products they would develop. At the same time NHS England produced their own report on delegation, bringing together some of the issues that had come up through the earlier phases of the project and wider experiences of the sector.
The aim of this phase was to build a repository of useful information that anyone interested in training and assessing the competence of their personal assistants could pick up and adapt or further develop for their own use.
Overview of models
- The PA training model in Nene CCG
- The PA training model in South Warwickshire
- Oxford [To follow]
- The PA training model in Tees
- Training PAs in Nene CCG
- Northampton 2 [To follow]
- Delegation and Training PAs in South Warwickshire
- Expanding PA Training Programmes to Adult Services, South Warwickshire
- Oxfordshire 1 [To follow]
- Oxfordshire 2 [To follow]
- Training PAs in Tees
- Maintaining Standards of PA training, Tees
- Matt’s story https://www.youtube.com/watch?v=hV3C854unL4
- Manish’s story https://www.youtube.com/watch?v=oBmH-ZF4ktA
Additional useful documents:
Disclaimer: Please note that these documents are worked examples only. Any organisation who implements or adapts the contents does so entirely at their own risk, not at the risk of the originators.
Nene CCG recognise the need to develop training opportunities for PAs so that the care they deliver to Personal Health Budget Holders is high quality and meets best clinical practice. During 2014/15 they participated in the pilot examining the use of QCF Units to train PAs on delegated healthcare tasks. However, it was agreed that the approach was not sustainable due to the size of the units and number of PAs needing training and assessing in clinical healthcare tasks. During 2015/2016 they have been developing a model of training provision that meets their local needs.
During 2014/15 NHS North of England Commissioning Support Unit participated in a pilot examining the use of QCF Units to train PAs in delegated healthcare tasks. The organisation found that using full QCF units was not sustainable; the low numbers of learners led to high training and assessment costs. So, in 2015/2016 they have been developing a model of training provision that meets their local needs.
- Report: Personal health budget PA training project demonstrator site project report, South Tees
- Training – Respiratory
- Training – Accountability
- Training – Pressure ulcer
- Training – Dysreflexia
- Training – Tracheostomy
- Costings spreadsheet
- Zip folder of competencies, Standard Operating Procedures and Training Packages
- Presentation: Personal Assistants, HCA’s delegation, training and accountability
Oxford Health NHS Foundation Trust has a well-established model for NHS clinicians to delegate healthcare tasks to PAs and other paid care workers. This is known locally as the Shared Care Protocol. It consists of an agreed list of healthcare tasks that can be delegated by a clinician to a paid care worker once they have received client specific training on each healthcare task to be delegated. They have been exploring ways to revise and update their existing model of delegation and training.
South Warwickshire NHS Foundation Trust has a longstanding process for the delegation of healthcare tasks to PAs and carers of children with complex needs, supported by e-learning and skills based training. They have been exploring the expansion of the current model of training from children to young adults.