Delegated Healthcare Tasks: Who Can Train a Carer

What the words mean

A delegated healthcare task is a clinical job formally handed to a carer

If somebody has told you the district nurse could train your relative's carer to do the feeds, this is the arrangement they mean. It has a name and national principles behind it, and a vocabulary that gets used around you without anybody explaining it.

The words you will hear

Delegated healthcare activity: An activity, usually clinical, that a regulated healthcare professional hands to a paid care worker or personal assistant. A ward may call it a delegated task or intervention.
Delegation: Defined by the Nursing and Midwifery Council as the transfer to a competent individual of the authority to perform a specific task in a specified situation.
Delegator and delegatee: The regulated professional who hands the task over, and the carer who takes it on once trained and assessed.
Competence: The knowledge, skills and ability to carry out the task safely without being supervised. Assessed for one task and one person, not in general.
Supervision: The professional watching the activity until the carer is competent and confident, and afterwards at an agreed frequency.
Individual employer: A person, family member or legal representative who directly employs a personal assistant, usually through a direct payment or personal health budget.

The line matters because it changes who is allowed to do what. Washing, dressing, cooking, and prompting or handing over tablets that have already been dispensed are personal care, and an experienced carer does those on their own account. Putting a feed or a medicine down a gastrostomy tube is not. The Care Quality Commission treats medicines given through a feeding tube, and injections such as insulin, as clinical or nursing tasks that a registered nurse can delegate to a care worker. Until that delegation has happened properly the task is not the carer's to do, however willing they are. What complex care means sets out the wider picture, complex care covers what carers on PrimeCarers take on, and can a private carer give medication? covers the ordinary medicine round.

Who can hand it over

Only a regulated healthcare professional can delegate a healthcare task

This is the part that is easiest to get wrong, usually with the best intentions. Somebody has done the task for months and offers to show the new carer how. That is not delegation, and it leaves everybody unprotected.

Who can delegate a task to a carer

A registered nurse, most often the district or community nurse who already visits
A nursing associate, an occupational therapist, a paramedic or a speech and language therapist, where the task sits inside their own scope of practice
A specialist nurse attached to the condition or the equipment: an enteral feeding nurse for a gastrostomy, a continence nurse for a catheter, a tracheostomy nurse for an airway
The hospital team before discharge, where the task begins on the ward and carries on at home

Who cannot

A family member, however long they have been doing the task themselves. The national guiding principles are written for paid care workers and personal assistants, and say plainly that they do not cover unpaid carers
Another carer who has done the same task for somebody else and offers to show the new one
A training company selling a certificate. A course teaches the theory; competence for your relative is assessed by the professional who delegates
PrimeCarers. We are an introductory service, we hold no CQC registration, and we take no part in the clinical side of anybody’s care

The professional delegating has to be competent in the task themselves. Under the NMC Code, a nurse may only delegate tasks within the other person's competence, has to make sure they are adequately supervised and supported, and has to confirm that the outcome meets the required standard. If an incident is serious enough to reach the NMC, the regulator will look at the decision to delegate as well as at what happened afterwards.

Task by task

PEG feeds, suction, catheter care and the tasks around them

With that in place, here is where the common complex-care tasks usually sit and who would normally teach them. Treat it as what to expect from the conversation rather than as permission, because the decision belongs to the professional responsible for your relative.

	Who normally does it	Can it be delegated to a carer?	Who would train and sign off
PEG or gastrostomy feeds and flushes	A nurse, or a family member or carer who has been taught	Yes. CQC gives caring for somebody fed through a PEG, delegated by a district nurse, as an example of what a care worker can do	The delegating nurse, usually with the enteral feeding nurse who supports the pump and feeds
Medicines given down the feeding tube	A nurse	Yes, with conditions. NICE names a PEG tube as its example of a medicine needing specific skills, and sets four conditions before delegation	The delegating nurse, with the pharmacist advising on which medicines can go down a tube
Emptying and changing a catheter bag, and hygiene around it	A carer, a family member or the person themselves	Yes. CQC names catheter care among the nursing tasks that can be delegated with additional training	The district nursing or continence team
Changing the catheter itself	A doctor or a nurse, at least every three months for an indwelling catheter	Not routinely. The NHS says it is sometimes possible to teach you or your carer, so it is a decision for the nursing team rather than an assumption	The continence or district nursing team, if they teach it at all
Tracheostomy care and suction	A nurse, or a family member or carer taught by the hospital	Sometimes, under a written plan from the team that manages the airway. There is no national rule either way, and emergencies stay clinical	The ward team before discharge, then the respiratory or tracheostomy nurse
Stoma bag changes and skin care	A carer, a family member or the person themselves	Usually treated as everyday care once the stoma is established, but ask for it in the care plan either way	The stoma care nurse
Insulin and other subcutaneous injections	A nurse, or the person themselves	Yes, with specific training. CQC names subcutaneous injection as a nursing task that can be delegated	The diabetes specialist nurse or the district nursing team
Intravenous medicines	A nurse or a doctor	No. Giving medicines intravenously sits inside the regulated activity of treating a disease, disorder or injury	Not applicable

PEG or gastrostomy feeds and flushes

Who normally does it: A nurse, or a family member or carer who has been taught
Can it be delegated to a carer?: Yes. CQC gives caring for somebody fed through a PEG, delegated by a district nurse, as an example of what a care worker can do
Who would train and sign off: The delegating nurse, usually with the enteral feeding nurse who supports the pump and feeds

Medicines given down the feeding tube

Who normally does it: A nurse
Can it be delegated to a carer?: Yes, with conditions. NICE names a PEG tube as its example of a medicine needing specific skills, and sets four conditions before delegation
Who would train and sign off: The delegating nurse, with the pharmacist advising on which medicines can go down a tube

Emptying and changing a catheter bag, and hygiene around it

Who normally does it: A carer, a family member or the person themselves
Can it be delegated to a carer?: Yes. CQC names catheter care among the nursing tasks that can be delegated with additional training
Who would train and sign off: The district nursing or continence team

Changing the catheter itself

Who normally does it: A doctor or a nurse, at least every three months for an indwelling catheter
Can it be delegated to a carer?: Not routinely. The NHS says it is sometimes possible to teach you or your carer, so it is a decision for the nursing team rather than an assumption
Who would train and sign off: The continence or district nursing team, if they teach it at all

Tracheostomy care and suction

Who normally does it: A nurse, or a family member or carer taught by the hospital
Can it be delegated to a carer?: Sometimes, under a written plan from the team that manages the airway. There is no national rule either way, and emergencies stay clinical
Who would train and sign off: The ward team before discharge, then the respiratory or tracheostomy nurse

Stoma bag changes and skin care

Who normally does it: A carer, a family member or the person themselves
Can it be delegated to a carer?: Usually treated as everyday care once the stoma is established, but ask for it in the care plan either way
Who would train and sign off: The stoma care nurse

Insulin and other subcutaneous injections

Who normally does it: A nurse, or the person themselves
Can it be delegated to a carer?: Yes, with specific training. CQC names subcutaneous injection as a nursing task that can be delegated
Who would train and sign off: The diabetes specialist nurse or the district nursing team

Intravenous medicines

Who normally does it: A nurse or a doctor
Can it be delegated to a carer?: No. Giving medicines intravenously sits inside the regulated activity of treating a disease, disorder or injury
Who would train and sign off: Not applicable

Sources: CQC guidance on delegating medicines administration, on training and competence, and on the scope of registration; NICE guideline NG67 recommendation 1.3.5; the Skills for Care guiding principles; and NHS guidance on living with a urinary catheter. September 2026.

A catheter bag change and a catheter change are different jobs, and it is easy to agree to one while a nurse believes you agreed to the other, so say which one you mean. Catheter and stoma care at home covers the daily routine.

Training and sign-off

What the training and the sign-off should look like

Seven stages sit between a nurse deciding a task could be handed over and a carer safely doing it. If your relative's arrangement has skipped one, this is where you will see which.

Stage 1
A regulated professional decides the task can be handed over
Who does this: The nurse, nursing associate, occupational therapist or other regulated professional responsible for that part of the care
They assess your relative and decide whether this particular task can be carried out safely by a carer for this particular person. There is no national list of tasks that may or may not be handed over, so the answer is worked out person by person, and the professional has to be competent in the task themselves before they can pass it on.
Written down: The decision, and the reasons behind it
Stage 2
Your relative agrees, and can change their mind later
Who does this: Your relative, or whoever makes decisions on their behalf if they cannot
Consent comes before anything else happens. Your relative can decline at the start or withdraw their agreement at any point afterwards, and nobody is under a legal duty to take a healthcare task on. Where your relative cannot make the decision themselves, it is made in their best interests under the Mental Capacity Act 2005.
Written down: The consent, and who was involved in the decision
Stage 3
The task and its limits go into the written care plan
Who does this: The professional who is delegating, with your relative and the carer
The plan should name the activity, say where the limits of it are, set out how risk will be managed, and give the carer somebody to ring for advice or to escalate a concern, including out of hours. It should also say what happens if the carer cannot attend.
Written down: The activity, its limits, the risks and the escalation route
Stage 4
The carer is taught the task on your relative's own equipment
Who does this: The professional who is delegating, or somebody they are satisfied is competent to teach it
Training covers the task and the person together: their tube, their pump, their bags, their routine and what a bad day looks like for them. A specialist nurse often does the teaching, such as an enteral feeding nurse for a gastrostomy or a continence nurse for a catheter, and where the task starts on a ward the hospital team teaches it before discharge.
Written down: What was taught, by whom, and when
Stage 5
The carer is watched doing it and signed off by name
Who does this: The professional who is delegating
Being shown a task is not the same as being competent at it. The professional observes the carer doing it, assesses them, and signs to say they are competent. The sign-off belongs to that named carer for that named person, not to a household, an agency or a certificate.
Written down: The title of the training, the date and length, the assessment, the trainer and the date the next review is due
Stage 6
The carer works to the plan and escalates instead of deciding
Who does this: The carer
The carer carries out the task as written, records what they did, and reports any change. They must not make a clinical assessment or a clinical judgement, and if something falls outside what was agreed they stop and ring the number in the plan.
Written down: What was done, each time, in the shared notes
Stage 7
It is reviewed, refreshed, and can be stopped
Who does this: The professional who is delegating, with everyone else involved
The professional keeps monitoring your relative and keeps checking that handing the task over is still the right thing. Competence is reassessed on an agreed timetable, and sooner if needs change, equipment changes or anyone raises a concern. Your relative, the carer, the family or the professional can all stop the arrangement.
Written down: Each review, and any retraining that followed it

What is never handed over, at any stage

The clinical assessment of your relative
The healthcare planning that follows it
Any clinical decision or judgement about treatment

Those three stay with the regulated professional for as long as the arrangement runs.

Stages drawn from the delegated healthcare activities guiding principles for health and social care in England (Skills for Care and the Department of Health and Social Care, revised November 2024), the Nursing and Midwifery Council’s guidance on delegation and accountability, and NHS England’s guidance on delegating healthcare tasks to personal assistants.

Stage five is the one worth checking, because a certificate from an online course can look like proof of competence when it is not. A course teaches the theory, and what it cannot say is that this carer can work this pump, on this tube, for this person. NICE asks for competence to be assessed through direct observation, and for anyone supporting medicines to have their knowledge and skills reviewed at least once a year. Where the task begins on a ward, ask for the teaching to start before your relative comes home: what to arrange before discharge day covers the rest of that list.

Who is answerable

Who is answerable for what, if something goes wrong

Accountability does not move across with the task. It splits, and the split tells you who to ring and what each person is expected to have done.

The professional who delegated

They stay accountable for whether handing the task over was appropriate at all, and may be asked to explain that decision. The clinical assessment, the care planning and the ongoing review remain theirs. They are not accountable for how the carer performed it, provided the delegation was sound.

Accountable for the decision, and for the clinical care

The carer

They are answerable for agreeing to take the task on, for following the care plan, for working inside their training, and for recording what they did. They must not make a clinical judgement, and must escalate rather than improvise.

Accountable for accepting it, and for how they do it

Whoever arranges and pays for the care

Where a registered provider employs the carer, it accepts the delegation and carries vicarious liability for its staff. Where a family employs a personal assistant directly, NHS England expects the delegating professional to advise them, and the family to check that appropriate insurance is in place.

Responsible for the arrangement around the task

PrimeCarers

We introduce carers and then step back. We do not supervise or monitor a carer’s work, we hold no CQC registration, and we have no role in delegating, training or assessing.

Not part of the clinical chain

A carer you engage directly

Where a self-employed carer engaged directly by the family sits

This is where the national guidance runs out, and it is better to say so than to guess. Here is what is settled, what is not, and what to put in place either way.

Two arrangements are written about clearly. One is a care worker employed by a CQC-registered home care provider, which accepts the delegation, holds the policies and the insurance, and carries liability for its staff. The other is a personal assistant employed directly by the person or their family through a direct payment or a personal health budget, the route NHS England's guidance covers.

A self-employed carer engaged directly under a contract for services is neither. The Care Quality Commission does not regulate that arrangement, because personal care arranged privately between a person and an individual care worker, with no agency directing it, is exempt from registration. So there is no registered provider standing behind it, no registered manager to accept a delegation, and no employer to carry vicarious liability, and the national principles do not say what becomes of the individual employer's responsibilities when nobody is the employer. In practice the decision sits with the community team, who delegate to a named individual and may decide not to. Do self-employed carers need to be registered with the CQC? explains the exemption, which is also why an introductory service such as PrimeCarers is not registered.

1
Ask the nurse before you book anybody
First conversation
Ask whether they would consider delegating this task to a carer working directly for your relative, and what they would need to see. Their answer decides whether you are looking for a carer or a nursing visit.
2
Get the task, its limits and the escalation route written down
In the care plan
The activity, its limits, how risk is managed, and who to ring for advice out of hours. A carer alone in a house at nine in the evening needs a number that is answered, not a name.
3
Ask who will train and assess, and by when
Named person, named date
Ask for the trainer by name, the date of the assessment, and a copy of the training record afterwards. CQC also asks the nurse and the carer to record their shared understanding of accountability and liability, so ask for that page too.
4
Check the carer’s insurance covers this task
In writing from the insurer
Being insured while working is not the same as being covered for a delegated clinical task. That is a question for the carer’s insurer, and NHS England expects whoever arranges the care to check it. Ask before the first feed.
5
Agree what happens on a day the carer cannot come
Before it happens
A carer may send a substitute, and the sign-off does not travel with them, because delegation is to a named person. Agree whether the nurse covers that day, whether a second carer is trained too, or whether the task pauses.

Finding a trained carer

Finding a carer who already has the experience, and what to ask

A carer who has done the task before is easier to get signed off, because the assessment starts from experience rather than from nothing. They still have to be assessed for your relative.

When you are ready to look, you can search for carers near you and compare their rates by postcode, and filter for the conditions and tasks a carer says they have worked with. Carers write their own experience on their profile, and their reviews sit there too. What PrimeCarers checks before a carer appears is their identity, their right to work, an enhanced DBS on the Update Service, and an online interview. We do not check qualifications or training, so the experience and any existing sign-off are for you to ask about and for the nurse to assess. Carers are self-employed and are insured while they work, which private carer insurance explains.

Questions

Questions families ask about delegated healthcare tasks

Yes, once a registered nurse has decided it is safe for that person, your relative has consented, the task and its limits are written into the care plan, and the carer has been trained and assessed as competent. CQC gives caring for somebody fed through a PEG, delegated by a district nurse, as an example of an activity a care worker can carry out. Until that has happened it is a nursing task.

The professional who delegates does the training, or satisfies themselves that whoever does it is competent to teach it. That is often the district nurse alongside the enteral feeding nurse who supports the pump and the feeds. On who pays there is no national rule: the guiding principles ask local health and care systems to agree funding between them, so it varies by area and is worth asking about early.

There is no national guidance written for that arrangement, so it depends on the local community team. The guiding principles cover care workers employed by a registered provider, and personal assistants employed directly by a person or their family. A self-employed carer engaged under a contract for services is neither, and nothing in the guidance allows or forbids it. Any delegation would be to that named carer, after training and assessment.

There is no qualification that entitles a carer to do it. Competence is assessed for one task, one person and one set of equipment, by the professional responsible for that part of the care. For an airway the teaching usually starts with the ward team before discharge and continues with the respiratory or tracheostomy nurse, under a written plan.

No. Delegation has to come from a regulated healthcare professional, and the national principles say plainly that they are not intended to cover family and unpaid carers. Your experience still matters, and the nurse will want to hear what a bad day looks like for your relative. The training and the sign-off have to come from the professional.

Ask what would need to change, and write the answer down. It may be the carer's experience, the equipment, how stable your relative is, or the team's own capacity to train and review. Ask whether nursing visits can cover the task instead, and whether it can be looked at again in a few weeks. A refusal is a clinical judgement they are entitled to make.

Yes. They remain accountable for whether delegating was appropriate, keep the clinical assessment and the care planning, and keep monitoring your relative and reviewing whether the arrangement should continue. Competence is reassessed on an agreed timetable, and sooner if needs or equipment change.

Who can train a carer to do a PEG feed or catheter care?

A delegated healthcare task is a clinical job formally handed to a carer

Only a regulated healthcare professional can delegate a healthcare task

PEG feeds, suction, catheter care and the tasks around them

What the training and the sign-off should look like

Who is answerable for what, if something goes wrong

The professional who delegated

The carer

Whoever arranges and pays for the care

PrimeCarers

Where a self-employed carer engaged directly by the family sits

Ask the nurse before you book anybody

Get the task, its limits and the escalation route written down

Ask who will train and assess, and by when

Check the carer’s insurance covers this task

Agree what happens on a day the carer cannot come

Finding a carer who already has the experience, and what to ask

Questions families ask about delegated healthcare tasks

Start with our guide to complex care

Looking for a carer with complex care experience?