Getting cover right: The insurance implications of delegated healthcare tasks

The adoption of delegated healthcare tasks in the care sector has been occurring for many years, and the pace of change will only accelerate. In this episode we talk delegated healthcare tasks: what they are and why they only make sense when they benefit the person receiving care. Hosted by Richard Lawson, Senior Account Executive at Howden Health & Care.

We sit down with Melanie Weatherley MBE, Co-Chair of the Care Association Alliance, and David Taylor, Executive Director and Head of Howden UK Health & Care to discuss the uncomfortable questions: who is competent, who is supervising, and who is actually liable when something goes wrong?

From an insurance perspective, we break down why delegated tasks are hard to define, how treatment-only policies can leave dangerous gaps, and why medical malpractice insurance is often the safer foundation when clinical delegation is on the table. The big takeaway is transparency: tell your broker and your insurer what you do, what you might do, and what controls you have in place, because CQC scrutiny and real claims both punish silence.

This episode is a must listen for anyone that works in social care leadership, risk or compliance.

Transcript

Welcome To Fortune Favours The Brave

SPEAKER_01 0:04

Welcome to Hamillin's podcast, Fortune Favours the Brave. We all take risks in our everyday life, and business is no different. In this podcast, we're speaking to the experts about the topical challenge or issue and what business leaders can do to overcome it.

Meet Our Guests And The Alliance

SPEAKER_03 0:19

Hello and welcome to this episode of Fortune Favours the Brave. My name is Richard Lawson and I'm one of the senior execs here at Howden Health and Care. In this episode, we're going to be discussing delegated healthcare tasks. I'm pleased to be joined by a couple of guests. First of all, I'd like to welcome David Taylor, Executive Director for Howden Health and Care. Hello, David. Hi Richard. And secondly, we're very pleased to welcome Menley Weatherly, Chair of the Care Association Alliance. Hi, Menley, how are you?

SPEAKER_00 0:49

Hello, Richard. I'm very well, thank you.

SPEAKER_03 0:51

Wonderful. So, Menley, I wondered if first of all you could start by giving us a short introduction to yourself and the Care Association Alliance and what the role is within the care sector.

SPEAKER_00 1:03

So I'm a late comer to the care sector, Richard. I came to care by accident, but it's absolutely where I need to be. And the Care Association Alliance is the national voice of local representation. We bring together over 50 local care associations who between them represent approximately 9,000 provider locations. And we describe ourselves as a critical friend for national and local government, other bodies such as the Care Quality Commission, but we try to be solution focused. So we will complain, but we don't whinge. And we don't win, or we don't complain unless we can suggest a better way.

Bravery Story With A Broken Ankle

SPEAKER_03 1:47

Thank you for that overview. With the Fortune Favours the Brave podcast, we do ask our guests to break the ice and tell us about a time that they were brave and it paid off. That can be a personal or something to do with the business and whether it's care related or not. Would you mind sharing something today?

SPEAKER_00 2:08

Yes, so I'm not sure whether this is personal or business or a bit of both, but um at the beginning of February 2026, I was on my way here to Haven to chair a session with yourselves and other members of the insurance community discussing delegated healthcare tasks. Walking down the street, something went pop, my foot went beneath me, and it turned out I'd actually broken my ankle, but I didn't know that at the time. I just got up, came here, chaired the event, and then went to get my um ankle seen too, and it must have paid off because I'm here talking to you and David Richard.

SPEAKER_02 2:46

And none of us knew on the day. That's what I find amazing.

Delegated Tasks For Better Patient Care

SPEAKER_03 2:49

Absolutely. Well, fighting through, you know, if you can fight through a broken ankle, I wouldn't want to be uh in the way when you're bringing things up to the uh uh other associations or or uh the the care quality commission. So let's go through then to delegated health care tasks. Menally, there's increased pressure on care homes and its workers. Now, how do you ensure that you are first of all covered to do these tasks and that it's not about saving the NHS resource and time, it's about getting the right care by a suitably trained person?

SPEAKER_00 3:30

Thank you for that, Richard. I think that's a really important question. The only reason we should ever do delegated tasks is for the benefit of the individual that that task is being delivered to or delivered with. And it's not just care homes, it's home care too. In fact, it's probably more important in home care than it is in care homes. Because in a care home, when you ask for a registered professional to come and help you and they're busy and they're not there, you can keep chasing. In home care, you leave and you hope that the district nurse or occupational therapist is going to visit. But if they don't, often you don't know until after they've closed, so it can be at least 24 hours before that support happens. So, yes, there is a lot of stress in the sector, but the important thing about delegated tasks is that you can deliver in a really timely way. Probably the most obvious one is skin integrity checks. If we notice and respond to changes in people's skin, the sooner we do that, the more likelihood there is that it's not going to be long-term damage. The best time to do that is when you're showering or dressing or bathing someone. But you're unlikely to have your district nurse standing outside the bathroom door. But if you can be upskilled to know what to do and who to tell, then that gets a much better outcome for that individual. It also means that they won't deteriorate badly enough to go to hospital. So it does in the long run save resources, but that must never be why we do it. It's got to be about the right care from the right person at the right time.

Defining Delegation For Insurers

SPEAKER_03 5:16

And David, I mean, with Men Lee's uh great points there, from an insurance point of view, how do they view delegated healthcare tasks? And and can you give us a rough idea of what is meant from an insurance point of view by a delegated task?

SPEAKER_02 5:33

Yeah, I mean the the challenge is it's it's not really defined. So I think the the issue really there is how do the insurers interpret what is a delegated task? And I think it's gonna simply be that is that the NHS are going to be asking whether it's home care providers, care home providers, um, to deliver certain types, slightly more clinical tasks perhaps than they're used to performing if it's a more of a personal care type situation. But it it yeah, it's going to be that the delegation of certain duties that currently might sit in the NHS into the world of care, be that at home, be that in a care setting. And I don't think that the DHSC. That's the Department of Health and Social Care are keen to define it in the sense of I think we heard that they they don't want to obviously produce a list of the types of things they're talking about. What what I've seen in terms of the sort of uh messages coming out that this could be administering insulin, catheter care and maintenance, uh it can be stoma care, peg feeding, but but into the the the realms of wound care and other sort of general bits and pieces, really, just to keep someone safe. So from an insurance perspective, I think that's yet to be properly defined. I think what we we need care providers to be conscious of is is two key things. One is is their duty to tell their insurance broker and their insurer uh what type of activities they are engaged in, because that has a significant impact on the insurance that they're purchasing. But also because the the insurance market is such that it is, the type of policy that they've already purchased and the suitability of that, because they may take on activities that are not appropriate to the policy they currently have. So I think it's going to be an evolving scene, to be honest, Richard.

Hidden Delegation And Funding Pressures

SPEAKER_03 7:39

I mean, back to you, Melanie. What are the key changes you're seeing and experiencing within care? And that's all businesses, as you mentioned, home care, care homes, uh potentially even supported living units. What what are you seeing and how are the businesses adapting at this time?

SPEAKER_00 7:57

I think there's a couple of things here, Richard. One is there are probably delegated tasks that we have been doing for years, but we didn't even realise there were delegated tasks. So we probably didn't tell our insurance broker or our insurer. So had anything gone wrong, we may or may not have been covered. The other thing is I think we're recognising that for our staff to have a career path, delegation of tasks is really, really helpful because they can grow in their skills but stay within the care sector, whereas previously they might have gone to health. And it's actually not just the NHS. Local authorities also have registered professionals who may also delegate some aspects of their statutory duties, such as care assessments, care reviews. And I think the other thing that's happening is when we did delegated tasks during COVID, at which point actually anything that anybody would do was delegatable. There was a little bit more money flowing around. The Department of Health and Social Care sent us grants towards our workforce retention, which had some strings, but they were quite relaxed strings. So one could use that to support delegation. Without that funding, and as local authority funding becomes more stretched and continuing healthcare, which is the NHS funding, is almost impossible to get, the goodwill for doing delegation informally has gone. And also, as we've realised quite what a responsibility it is, I think we're beginning to say we do want to do this, but we need to make sure it's done safely and we need to make sure that we're covered just in case the worst happens.

Treatment Cover Versus Medical Malpractice

SPEAKER_03 9:51

Thank you. I mean, David, back to you. Given these changes, and and Minley touched on the fact that potentially even had been going on previously without realizing that some of them are delegated tasks. What is the impact on the insurance market currently? And how can businesses be sure that they are covered to do these activities and that they are doing them safely?

SPEAKER_02 10:17

Really good, really good question. And I think um Melanie touched on it there that there's actually quite a bit of what what is going to be considered a delegated health task actually in the care sector today. Um and the the the other point that they may or may not be covered is is sadly very true. So the the market, the insurance market, is a is a spectrum, and no policies seem to be the same. And there's a there's a a start point of of covers with a multitude of insurers and quite a lot of business written on it, which is on a what's called a treatment-only basis, and you go from treatment covers right up to full what we would call medical malpractice insurance. Um, in terms of treatment, the cover there can be quite limited. It's it's usually administration of drugs and medicines. There might be an allowance for certain certain diagnosis for qualified registered nurses, but but that's probably the extent of it. And then you start to think about the sort of tasks that a care provider could be giving. And it's quite easy to fall outside the bounds of a policy as restrictive as that. So therein, I guess, lies that lies a big concern, particularly when you get into proper clinical covers where things get a little bit invasive, like the insulin, the catheter sort of care and things like that, where certainly a treatment policy is going to be wholly inadequate. Um, and that that is going to cause a provider a major headache. They they may not be thinking about it, and this is the problem that they will have bought a policy that says I'm a social care policy, and they think I'm going to be all right because I've got a bespoke policy for social care. That is not true. And this is why I guess I would always emphasize it's so important for providers to talk to insurance brokers that understand social care, a specialist in social care. Doesn't have to be Howden, but pick a specialist insurance broker because the generalists really, you know, don't deal with they don't deal with it day to day. They they won't be thinking, is this policy on a different basis? Are claims made or a claims occurring basis? These are technical pieces that fall within the insurance industry. The broker needs to advise the the provider, and uh it's so important that they get the proper technical advice when thinking of purchasing a policy, because you know, a slip here means if the worst thing happens, they're left high and dry. Um, and sadly, nobody wants to see that. So uh so yeah, the the med malpolicy, the medical malpractice policy, which you know we tend to provide much more frequently than a treatment only, is there for any form of, I suppose, clinical type work, but I would emphasize only where you disclose it to the underwriters and they they know you're undertaking that activity. So it's one thing to have the policy there, providing the right cover. You also have to disclose to the underwriters this is what we do, so that they can you know apply the appropriate terms. Failure to do so is where things get unstuck, unfortunately.

SPEAKER_03 13:43

Menley, I mean the Care Association Alliance is a leader. And is there things that you're considering or measures you're taking to make sure that your members are aware of all of these requirements, both from an insurance stance and a care provider stance?

SPEAKER_00 13:59

I think there are a couple of things we're doing here, Richard. The first thing is to try and raise awareness of how much delegation people are doing. The phrase that frightens me most as a care provider is a district nurse saying, Could you just? Because the care worker will hear that and they will say, Yes, of course. But almost inevitably, could you just do X or Y? Probably is in the delegated space. And it could be exactly the right thing to do, but we need the right governance. The other myth we're trying to squash is the view from a lot of nurses, which is that the all of the liability when tasks are delegated rests with them. The professional responsibility may well do because of their registration, but the insurance liability is likely to rest with the care provider. So that's the other thing we're doing, is saying, just make sure you're doing delegated tasks, or if you are, that you know you are, are you doing them safely and have you disclosed them to your insurance broker? We often talk about delegated tasks because it is one of the Secretary of State's key things, and I think he's right, I don't often say that, but I think he is right, that if we could get delegation to work properly, we would provide much better outcomes for a lot of our vulnerable adults because they often don't need an extra person to come and poke at them. The person who is delivering their care and support could do it with the right skills, the right oversight, and most importantly, that person needs to know what do I do when I don't feel comfortable? Either because I can't remember what I'm supposed to do, it doesn't feel right, or my service user isn't quite themselves today, or what I'm looking at, I've never been told to look for. So that's the key thing is can I pass that on? Can I raise that flag? So as an alliance, we we talk about delegation all the time. We are working with Skills for Care because they're looking at delegation and how we make it safer. We also talk to various bits of the Department of Health and Social Care about how we do this on a systematic basis. Because my other concern, Richard, is that it's done based on locality. So if you go to one part of the country, we do delegation in one way. You go to another part, we do delegation in another way. Now I'm not an expert, but I'm assuming that from an insurance perspective, that's about the worst thing you could possibly do. Because if you've got an apple over there and an orange over here, then somebody is going to say that what you should have done is whatever you didn't do. So we're trying to get some consistency, some regulation. But as David said earlier, we can't have a list. They will not give us a list. And I think I know why. I think because if there was a list of delegated tasks, there was an assumption that if you do one, you can do all. And that's not the case because some of them, if you get them wrong, you may cause a little bit of discomfort. And others, if you get them wrong, you could be looking at a coroner's court. So we do need to be sure about what we're talking about. And gradually we will end up with a long list because there will be things that are in people's insurance details, but there won't be a definite list because it will also change. There are some things you definitely can't delegate. You can't delegate brain surgery to a care worker. There are other things that used to be called delegation that are not anymore. Administration medication used to be a delegated task. It's not now, it's just part of whatever social care does. So I think it will evolve, but we need to be sure that the principles that we apply are applied consistently across the country. Or I don't think we're ever going to get real, proper, robust cover.

Disclosure Risks And The Changing Market

SPEAKER_03 17:52

David, back to you. In terms of you know, the providers of care, what are they risking if, as Menley said, they're they're not proactively uh seeking advice from a broker, not proactively looking for the appropriate cover. What are they risking at that point?

Registration Ideas To Make Delegation Safer

SPEAKER_02 18:12

Well, uh, I guess ultimately you you're risking your livelihood, aren't you? Because um uh uh Menley said there, you if you if you end up in a coroner's court and uh it doesn't go your way, you know, reputationally alone could be the end of the road, let alone financially. So uh you know, providers do do need to be really conscious of the activities that they're going to take on, but pass the responsibility, pass the accountability to their broker. I've told you what we do, and it's up to that broker to find the right market, the right insurer with the right policy to cover them. You know, they are then accountable if that doesn't work because they know what the insured does. They they take on board the risk, really, by by knowing. But the onus is on that that provider to to disclose this is what we do, you know, and this is this is the you know the extent of it. So uh, but yeah, look, insurers, uh what I don't know, I guess what none of us know at this moment in time is is how prevalent the these um delegated health care tasks are going to be. You know, will treatment risks still have a place in the market? You know, that some providers don't do delegated healthcare tasks. They they just decide decide to keep within you know that their their specific lines of of work. So, you know, but I but assuming it uh you know that the direction of travel is quite prevalent, I I could see an end to treatment covers, and that might take those insurers out of the market potentially, because you know, a lot of the time the treatment providers are not medical malpractice insurers. So it could change the market. It doesn't mean prices are going to change. I think the conversation we've been having, which is actually some of these insurers are aware that they're they're involved with stomach care or with peg feeding and things like that. That's part of it. And they set their pricing based on the claims performance. So uh whilst rightly there's not going to be a list, I think we're all accepting the list is probably not going to happen. Insurers, certainly when we spoke, you know, are interested more in a tiered approach. So, you know, there's a high-risk, medium risk, low-risk type activity that they're taking on board, and they can watch and uh manage how those things perform. They might adapt accordingly. But I I sense as as these healthcare tasks become more common, uh a medical malpractice wording is probably the only correct way to go to ensure that at least the cover's there, and the only conversation then is about disclosure, you know, or non-disclosure, if it was omitted, which is an easier conversation for brokers to have that debate with an insurer, if that's where it falls down. But if if the cover's not there because it's a treatment policy, you're not going to get anywhere with a with an uninsured loss of that type. So critical, you know, that um providers talk to their broker openly and honestly. What we think we would like to do, even if we're not quite doing it yet, because these things are annual policies, and quite often insurers providers wouldn't necessarily think. And I think the example of would you just you know do something? You you you you suddenly you've taken something on, no one's gonna think I'll do it, but I better phone my insurance broker. They'll they'll just do it. So I think setting the Right terms at the beginning of a period of insurance, you know, based on the concept of what might we do is better than trying to adapt on the fly as you go through the year.

SPEAKER_03 22:11

Absolutely. And I mean, do you have any examples where a provider has had a treatment policy and circumstances have dictated that they require a medical malpractice policy? And what can a broker do to help in that instance?

SPEAKER_02 22:27

Well, in a positive way, I can say I I don't. I mean, uh uh how we don't tend to um sell that many treatment policies unless we're absolutely certain that the extent of you know their activities is suitable to that. So, but I've I've heard the horror stories. So it it happens, but I think it just goes back to my point that I think the way this is developing, the treatment type insurer and policy is going to reach the end of its road, and either those insurers adapt what they're giving or they're probably going to wind up and not be in the market any longer. The medical malpractice insurers will survive, and I think that's probably the right way for any care provider that's going to contemplate a delegated healthcare task, you know, get full provision of insurance cover. So thankfully, you I don't have any Halden examples of that, but um, I know they exist. Um and from a client that has a situation where they've stepped beyond the policy scope, uh you'll know the outcome, which is that the the insurers will refute the claim, point the exclusion, and walk away. And that leaves the provider in a uh a terribly difficult situation, potentially with compensation, uh, potentially with closure. So it it's it's a critical thing that you know people pay attention to this.

SPEAKER_03 23:53

Yeah, very much so. And back to you, Menley. Obviously, we're advancing the conversation, um, and there's emerging risks. It seems to me, from the conversation that we've had today, that transparency is key.

Saying No And Keeping Staff

SPEAKER_00 24:09

Absolutely. And I think we need to remember there's a risk if we don't do this. The risk is that our NHS will get more and more stretched. Frail older people or people with learning disabilities will be receiving inappropriate treatment, either because it's delayed or because they have to go seek it when actually it could have been done where they were. So it's not risk-free to carry on doing what we're doing, but that's probably not an insurable risk. Or at least it's not my problem as a care provider. And the NHS has its own way of insuring things, so that's not our concern. But I think, yes, it's about clarity, who's doing what, when, and why. And I think that takes me on to one of the things that we're leading on as a care association alliance is we need to be able to be really sure which providers are doing or or are open to delegation and which ones are not, and whether that should be recompensed differently. Because the easiest way for the department to fund this would be to say that care provider does delegation, we pay X per year per person or whatever. And then similarly, with the people who are doing the who are prepared to be delegated to, is could they be recognised? If they were a registered role, a bit like the nursing associate, then a lot of the concerns would disappear because they would know what their scope of practice was, what their code of practice was, and that would make the person doing the delegation feel a lot safer. It would probably make the insurance market feel safer, because we would you we would be asking you to ensure the activities of a group of registered professionals, you would understand what that was, what competence they had. They still would need to be delegated to. We're not suggesting that the responsibility passes, but the person doing the delegation knows the knowledge and expected competence of the person they're delegating to, and they simply have to check that this delegation is appropriate for this person at this point in time. And that's the thing we're really trying to say is we can't carry on doing it like licorice all sorts. It is because something is going to go wrong, and then it will all stop, and we'll go back to not having an issue to solve the current risk. But if we could recognise a care provider that had said, yes, I will do delegation, might not be doing it this week because I might not need it this week, but I'm ready to do it, I've got the right insurance cover, and that I think would help with the Care Quality Commission, because they want transparency. And actually, Richard, you don't even need to have a problem for it to be a potentially existential threat. If CQC came along and said, Are you insured for everything you do? And the answer is no, then you are breaking the Health and Care Act. And they could, if they wanted to, take your registration away. So it doesn't have to be something goes wrong. You have to just not be insured when the inspector calls.

SPEAKER_03 27:16

Absolutely.

SPEAKER_02 27:17

I think it's also quite important that the recipient of the delegation understands the extent of that authority, is I can do this but no more. And if it gets to a point where I could do that, but I'm not trained and I'm not, you know, supervised to do that bit, that there needs to be that that handover back, really, you know, because insurers will look at what were you trained to do, what are you supervised to do. If you breach that, suddenly you're probably, you know, pushing the bounds of whether your insurance policy is going to adequately cover you. So it's just knowing the the confines within which you're working and which you've taken on delegated tasks. Stick to it and and don't go beyond, really.

SPEAKER_03 28:04

I mean, there are great points there, David. Uh back to you, Ben Lee. I feel like that is a cultural thing within care as to whether care leaders are ensuring that their teams know when to escalate, when they can potentially say no, and that they don't feel a pressure to do things that they're not supposed to. I mean, what do you feel the future holds for care and the businesses and the staff that work on the day-to-day to support the most vulnerable amongst us?

SPEAKER_00 28:37

I think you're right, and I think that in my mind goes with registration. If I am registered, I am allowed to say no. Registered nurses, doctors will say I'm not competent to do that today because and nobody then pressurizes them to complete that. But if you're a care worker who doesn't have a professional status, I think there is a huge risk that people are asked to do things that they don't feel comfortable doing, and then they leave. So that is the other risk. If you are asked every day to do things that you feel might be dangerous and that you're not comfortable doing, and you don't know where to go when you get to your boundary, the easiest thing to do is to say, I'm going to go sit on the checkout at Aldi because there isn't any risk there. Might not be as satisfying, but there's no risk. So again, I think that takes us back to the care worker needs to be recognised as a link in the chain of care and treatment, but a link that is just as important as the doctor who prescribed the treatment in the first place.

Contact Details And How To Subscribe

SPEAKER_03 29:45

Wonderful. Unfortunately, I feel that we could talk about this forever, and and and it's it's so intriguing, but that's all the time we have on this episode. Um I'd like to thank you both very much for joining me. Menli, just one last point. Is there uh somewhere you can direct people to contact you if they have questions, um, if they want to talk about the uh Care Association Alliance?

SPEAKER_00 30:11

So my email is chair at Linka Limca.org.uk, which is Lincolnshire Care Association, which is a member of the Care Association Alliance.

SPEAKER_03 30:25

Wonderful. And thank you ever so much. On that, we say goodbye.

SPEAKER_01 30:30

Thank you for listening to this episode of Fortune Favours the Brave from Howden. To hear more episodes and subscribe to our channel, search Fortune Favours the Brave on your favourite podcast app.