Delegated healthcare
in Greater Manchester
Developing better understanding of delegated healthcare activities.
Research summary
October 2024 – December 2026
Our research has developed understanding of delegated healthcare in Greater Manchester, where NHS community nurses delegate activities such as insulin administration to adult social care workers from private sector care providers.
We asked those involved how these delegated healthcare activities (DHA):
- affected the experience of people receiving care and their carers (usually family or friends who provide unpaid care and support)
- affected working conditions for care workers (who are paid to provider care and support)
- impacted the quality of adult social care
The population of England is getting older, and more people need adult social care (ASC), including support with personal care, either in their own homes or in care homes. ASC workers provide this support.
People may also need healthcare which is delivered by community nurses. This can lead to problems, including too many visits from health and social care staff or missed visits. There is also a shortage of ASC workers, which puts pressure on health and social care systems.
There’s a need to rethink the roles of the people providing these services. One option is delegated healthcare – known in Greater Manchester as ‘blended roles’ – where ASC workers take on some activities traditionally done by community nurses. While this is happening in practice, there is not enough evidence on how well it works and what it achieves.
This research provides an evidence base for DHA, potentially improving care workers working lives and the quality of care experienced by the people they care for.
What did we do?
To improve the evidence, our research:
- Looked at existing information and research to see what’s already known.
- Talked to health and social care workers, people receiving care and their carers, and other people involved in DHA to understand their experiences and assess the outcomes of DHA.
- Developed a framework to measure how well DHA work and recommended what information needs to be collected to do this measurement. This helps to create a way to evaluate how effective DHA are.
- Used the information we gather to create a toolkit for health and care leaders to guide the effective implementation of DHA. The toolkit can be found here: Home – DHA
Research team
Research lead
Collaborating with:
- University of Liverpool (academic support)
- University of Salford (academic support)
- Oldham Metropolitan Borough Council (health and social care support)
- Rochdale Metropolitan Borough Council (health and social care support)
- Tameside Metropolitan Borough Council (health and social care support)
- Northern Care Alliance (public and community involvement and engagement)
Throughout the study, we worked with:
- a project steering group involving the Department of Health and Social Care, NHS representatives, local authorities, care managers and care workers, and public and community involvement and engagement representatives. The group helped ensure results have a wide uptake by policymakers and those working in the sector.
- a public and community involvement and engagement (PPIE) group that represented the views of care workers and people receiving care and/ or their families.
With funding from
The views expressed are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Policy Research Programme.
Project enquiries
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