Delegation guidance

Responsibility

As registered practitioners and members of the RCSLT, SLTs must adhere to the HCPC standards and follow RCSLT guidance related to delegating and working with others, whatever the work situation or role.

HCPC standards of conduct, performance and ethics

Delegation, oversight and support

4.1 You must only delegate work to someone who has the knowledge, skills and experience needed to carry it out safely and effectively.

4.2 You must continue to provide appropriate supervision and support to those you delegate work to

See also:

• Key Area 7 – Report concerns about safety
• Key Area 8 – Be open when things go wrong
• Key Area 9 – Be honest and trustworthy

Terminology

There can be a difference in the use of terminology in different settings. For consistency, the same words are used throughout and where necessary definitions are included in this terminology.

Accountability

Accountability means being answerable for the decisions made in the course of one’s professional practice. Accountability cannot be shared.

Assignment

If a task is assigned to someone both the responsibility and accountability for the activity passes from one individual to another.

Competence

• An individual’s ability to effectively apply knowledge, understanding, skills and values within a designated scope of practice.
• Evidenced in practice by the effective performance of the specific role and its related responsibilities.
• Involves individuals in critical reflection about, and modification of, their practice.

Delegation

The allocation of work from a registered SLT to another member of the SLT workforce (registered SLT, student SLT, SLT support worker). The person to whom the task is delegated has responsibility for the delegated task, while the registered practitioner retains accountability.

Empowerment

Individuals able to make decisions and have control over their own lives.

Enablement

SLTs pass on information, techniques and skills to service users, families, and unpaid carers in order to increase autonomy and independence through:

• supporting them to continue activities modelled during therapy
• facilitating communication and/or eating and drinking
• developing supportive environments

See also our guidance on enabling service users.

Interdisciplinary team

This term is used to mean a multi-professional team which will involve a range of different people depending upon the context e.g. other AHPs, medical and nursing staff, social work staff, education staff.

Responsibility

Responsibility is the obligation to perform duties, tasks or roles. Responsibility can be shared.

Role emerging student placements

This term was used originally by occupational therapists (OTs) to cover student placements in areas where there was not an OT on site. The term is used here to mean any non-traditional student placement where there is not an SLT on site, e.g. an independent care facility for adults.

Service user

This term is used to include any person with a speech, language and swallowing issue accessing SLT services, e.g. client, patient.

SLT support worker

This term covers SLT support staff who will have a variety of different titles and accompanying job descriptions, e.g. SLT assistant, technical assistant, health care support worker (HCSW), reablement worker, assistant practitioner. This term does not cover support workers who are not part of the SLT service.

Types of training

We draw a distinction between:

• Training (transferring specific information and knowledge)
• Learning (the process of absorbing that information in order to increase skills and abilities and make use of it under a variety of contexts)
• Coaching – ongoing relationship to enhance knowledge or skills, eg working with parents in home environment
• Empowerment (increases an individual’s ability to make decisions and have control over their lives)
• Acquisition of skills and competencies by the person receiving the training

Upskilling the wider workforce

When SLTs share knowledge and skills and raise awareness with other key workers (eg clinical colleagues, education and justice system staff), in order to support the best outcomes for service users. The registered practitioner has no direct supervisory or managerial responsibility.

See also our guidance on upskilling the workforce.

Definition of delegation

The term ‘delegation’ is used by people in different contexts to mean a range of processes and relationships. They involve varying levels of accountability for the registered practitioner.

The definition of formal delegation is:

“The allocation of work from a registered SLT to another member of the speech and language therapy workforce (registered SLT, student SLT, SLT support worker).”

The registered practitioner has a legal responsibility to:

• have determined the knowledge and skill level required to perform the tasks within the work area(s)
• assess the competency of the person to whom they are delegating

The registered practitioner retains accountability for:

• the delegation
• ensuring that the outcome of the task is up-to-standard (Word)

The SLT support worker is:

• responsible for working within their level of competency
• accountable for accepting the delegated task and for his/her actions in carrying-out the task

This is providing that the:

• SLT support worker has the skills, knowledge and judgement to perform the assignment, and ability to critically reflect on their own practice and recognise when they cannot complete a task.
• delegation of task falls within the guidelines and protocols of the locality
• level of supervision (Word), support and feedback is appropriate to the task and the individual’s level of competence. The registered practitioner is responsible for ensuring that this is in place.

For useful information around delegation and competency see All Wales Guidelines for Delegation 2010 (PDF) (page 4).

Duty of care

The law imposes a duty of care on practitioners, whether they are registered staff, SLT support workers, assistant practitioners or others when it is “reasonably foreseeable” that they might cause harm to patients through their actions or their failure to act (Cox, 2010).

All practitioners must ensure that they perform competently. They must also inform a senior member of staff, when they are unable to perform competently.

Frameworks and policies around delegation

There are other frameworks and policies, which will influence individual SLT’s decisions about delegation, including:

• Job description, or contract if an independent practitioner, scope of practice and level of competency
• Organisational and other local policies
• Regulatory bodies depending upon where you work:
  • health
  • public health
  • social care
  • education
  • justice
  • third sector

The key aims of promotion participation in relation to delegation are:

• To promote the participation of individuals with speech, language, communication and swallowing difficulties in a full range of life activities.
• To contribute to raising public awareness of communication/eating and drinking difficulties
• To promote the participation of the individual with communication/eating and drinking difficulties in a full range of life activities through working in an advocacy role with services/groups.

Methods may include:

• Joint-working with other professionals
• Influencing agency-wide and inter-agency policies and strategies

Importance of clarity

As service-delivery models change, it is important to acknowledge that people understand the word ‘delegation’ differently.

Some of the difficulties (real and perceived) around ‘delegation’ can arise due to a lack of clarity about roles and responsibilities.

When working collaboratively with others, everyone involved should be clear about:

• The exact process being put in place
• What is to be expected
• Where responsibility and accountability lie (Word)

Definition of assignment

The term assignment means something different than delegation, and the following should be considered:

• If a task is delegated to someone, they are responsible for the delegated task while the registered practitioner retains accountability.
• If a task is assigned to someone both the responsibility and accountability for the activity passes from one individual to another.

When to delegate

Delegation of activity to another is a complex matter.

It is determined in the context of the relationship that exists between the person who delegates, and the person to whom some aspect of practice is delegated. See All Wales Guidance (PDF) for useful information.

The decision about which tasks and to whom tasks should be delegated to, should be based on the:

• Registered practitioner’s professional opinion
• Principles of Delegation (Word)
• Individual’s skills, competence, attitudes and experience
• Requirements of the client group
• Nature of the task in the specific circumstance
• Risk assessment

Please also see our checklist for delegation (Word).

It will also be influenced by:

• A job description, and linked competencies
• Service protocols which should clearly state the appropriate roles and responsibilities of support workers
• Skills mix in the team
• Particular settings in which the task is to be carried out

Delegation within the speech and language therapy workforce

To ensure delegation within the SLT workforce is appropriate, RCSLT recommends that the following principles should apply:

For full details of the principles of delegation, go to principles of delegation (Word).

Delegation to non-SLTs

In certain circumstances the term delegation is used when an SLT requests someone in another service, who is not an SLT, to undertake tasks. For example, a teaching assistant carrying over therapy activities in a school.

This relationship is different in terms of accountability and responsibility. In this situation, the SLT retains accountability for the outcomes of any SLT therapy activities, but does not have line management or supervisory responsibility for the person to whom the task is given.

RCSLT recognises that difficulties can occur in working across services and recommends:

• SLTs are clear about the line management and supervisory structure in place for staff to whom they are giving tasks. The SLT can then decide who is ultimately responsible for ensuring that the work is carried out.
• There is some form of formal agreement in place between the different services as to:
• Who is responsible for ensuring that the tasks are completed to the required amount.
• What training and subsequent ongoing support and monitoring may be required for those undertaking the activities
• How the tasks will be quality assured by SLTs.

The type of agreement will differ depending upon the situation.

Upskilling the wider workforce

A key role for SLTs is to share knowledge and skills, and raise awareness with other key workers (eg clinical colleagues, education, justice, and third sector staff), in order to support the best outcomes for service users.

For more details on upskilling and types of training and linked expectations, please also see our training section.

Enablement

For more information on enablement please the enabling service users section.

Benefits of delegation and upskilling of wider workforce

The speech and language therapy workforce seeks to improve outcomes for service users through working collaboratively with others.

Delegating inappropriately

If you have a concern that someone is delegating inappropriately this should be reported.

Seeking support

Delegating appropriately and working effectively in interdisciplinary situations are complex professional issues. They can cause concern for NQPs through to senior managers.

SLTs working in some situations may not have the same informal opportunities to reflect and share ideas as those working in a single site team situation. For example, if you working as an independent therapist or as the only Allied Health Professional (AHP) in a third sector organisation.

RCSLT recommends therefore that regular supervision is essential for everyone.

For further support, please see:

• RCSLT (general information and professional queries)
• Association of Speech and Language Therapists in Independent Practice (ASLTIP)
• Workforce services (in your organisation)

Delegation to speech and language therapy support workers

RCSLT recognises that speech and language therapy support workers – who can have a variety of job titles, play a vital role in the delivery of effective services and the skills mix of speech and language therapy teams and the wider AHP workforce.

Appropriate delegation of clinical and non-clinical tasks is both beneficial to all concerned and important for effective service delivery.

To maximise the contribution speech and language therapy support workers can make to a service’s skills mix requires confidence from:

• Registered practitioners to delegate activities
• Support workers in their abilities
• Employers aiming to provide an effective, safe and person centred service
• Service users that those who provide care are knowledgeable and competent

This section covers what is required when a task is formally delegated by the registered practitioner to a speech and language therapy support worker, for whom the registered practitioner has supervisory responsibility.

To ensure delegation is appropriate the RCSLT recommends that a set of principles of delegation should apply.

Delegation process

The delegation process from registered practitioner to speech and language therapy support worker is as follows:

Competence

For more information on assessing competence, dealing with inadequate competence and nation specific resources, please see the support worker hub.

Delegation and assessment

Initial diagnostic assessment of a client is one of an SLT’s key roles. This requires evidence-based clinical reasoning to determine a programme of treatment or care.

The RCSLT expects therefore that it will be a registered practitioner who:

• makes the clinical diagnosis, analyses and interprets assessment results
• generates possible therapeutic options in discussion with the service user

The speech and language therapy support worker will be expected to make decisions within the context of designated work with a service user, while working towards the aims set by the registered practitioner. This may mean that a speech and language therapy support worker working at more advanced levels (eg assistant practitioner) is able to:

• Plan and implement a therapy/treatment programme or care plan within the scope of their skills and training – reporting to the registered practitioner for re-direction and advice, as necessary
• Judge the service users progress and make some treatment decisions based on that judgement, assess and reassess the patient/client’s progress

Where a clear protocol for a service user group or pathway is in place the speech and language therapy support worker may have delegated discretion, and autonomy for some elements of continual assessment. These will be clearly defined and agreed.

It is essential that the role and specific activities of the speech and language therapy support worker are made explicit in the design of such protocols.

It is expected that a speech and language therapy support worker who is delegated a task will be competent to:

• Continually monitor and report changes in the service users’ responses
• Feedback relevant information to the registered practitioner(s).

This information will be included in supervision discussions, as HCPC states: “You must continue to provide appropriate supervision and support to those you delegate work to” (HCPC, 2016b, p7).

There should also be a mechanism in place for the speech and language therapy support worker to access support at other times, as required.

Accountability and duty of care

Registered practitioners are accountable to:

• HCPC and RCSLT in terms of standards of practice and duty-of-care
• an employer to follow their contract of duty and locally-driven policies
• the criminal and civil courts to ensure activities conform to legal requirements.

All clinical decisions concerning the client are the responsibility of the qualified SLT, including client selection for therapy, admission to the caseload and discharge from the service.

The qualified SLT holds the ethical and legal ‘duty of care’ for the client and therefore must always be responsible for the work undertaken by a speech and language therapy support worker.

The HCPC states: “You must continue to provide appropriate supervision and support to those you delegate work to” (HCPC, 2016b, p7).

The SLT may not always have line management or overall supervisory responsibility for the speech and language therapy support worker. This responsibility will be determined by local protocols and staffing structures. For example, a reablement worker in a stroke service may be supervised by another AHP in the team.

However the SLT retains accountability for supervision related to the delegated task, including monitoring of those tasks.

Professional liability insurance

Professional liability insurance can be the responsibility of the employer and also supplied by the RCSLT.

RCSLT insurance provides full cover against 3rd party actions and legal defence costs, for all members whether a fully certified therapist or associate member providing appropriate support and supervision is available and accessed regularly.

For more information on insurance, please see the RCSLT supporting information (PDF). All insurance related issues should be clarified before the speech and language therapy support worker starts working.

Speech and language therapy support worker and students

Supervision of speech and language therapy support workers

As with registered practitioners, supervision and continual professional development (CPD) is essential for speech and language therapy support workers to develop and maintain their skills.

The RCSLT has included effective supervision as one of the principles of delegation (Word). As the HCPC states: “You must continue to provide appropriate supervision and support to those you delegate work to” (HCPC, 2016b, p7).

As the registered practitioner, you are responsible for ensuring effective supervision is in place to someone to whom you delegate, whether they are:

• A new member of staff or experienced.
• Working as a single profession worker or across a number of disciplines eg reablement workers, AHP support worker.
• A speech and language therapy support worker for whom the registered practitioner does not have line management responsibility.

Delegation by newly-qualified practitioners (NQPs) to speech and language therapy support workers

NQPs can find delegation to support workers a difficult part of their job. They may require support and training to gain confidence to do so effectively.

Delegating to student SLTs

Delegation of work to student SLTs needs is to happen within the framework for supervision of students, detailed by the HCPC and individual universities.

For further information, please see:

• National Standards for Practice Based Learning

Competency development

Clinical education requires that students be given opportunities to develop competencies in all areas, including assessment. The appropriateness of delegation will depend on the student’s level of training.

This will typically be addressed in university practice education documents and in workplace agreements between HEIs and placement providers.

Caseload responsibility

While the student is on placement, the supervising SLT retains responsibility for the caseload. All processes of assessing competence and managing inadequate competence apply and are managed at all times in consultation with the higher education institute.

Remote supervision

In cases of role-emerging placements where there may not be an SLT on site, the supervising SLT, service-provider and higher-education institute need to establish clear lines of accountability and supervision, prior to the placement taking place. Any agreements need to include consideration of delegation of duties specific to that setting.

For further information please also see:

• Role emerging placements: building capacity and developing skills (PDF)

Delegation of tasks to the wider workforce

RCSLT recognises that SLTs do not have authority to formally delegate tasks to the wider workforce, unless they have managerial or supervisory responsibilities for their actions.

More information can be found in the upskilling of the wider workforce webpages.

Guidance

• Duty of care handbook (PDF) Practical advice on the duty of care of healthcare professionals and their employers, and what we must do to help protect patients and staff.
• NHS Knowledge and Skills Framework (PDF) an easy to use reference guide to the NHS Knowledge and Skills Framework (KSF), which supports Personal Development Planning and Review (PDP&R).
• The Calderdale Framework provides a clear and systematic method of reviewing skill-mix and roles within a service to ensure quality and safety for patients
• Time to Train: Development of an eModule for Swallow Screening Training (PDF) University College London Hospitals NHS Foundation Trust
• Assistant practitioner scoping project 2010 Royal College of Nursing

Policy England

Here you will find links to relevant national legislation, policy and frameworks.

Please note that this list is not exhaustive. Please contact us to propose any additions.

Please note: the resources on this page are provided for informational purposes only. No endorsement is expressed or implied, unless otherwise stated. While we make every effort to ensure this page is up to date and relevant, we cannot take responsibility for pages maintained by external providers.

• Standards of Business Conduct Policy: describes the standards and public service values which underpin the work of the NHS and reflects current guidance and best-practice which all NHS England staff must follow. (NHS England July 2017)
• Care Certificate – National Minimum Training standards (launched 2015)
• Assistant Practitioners in the NHS in England 2015 (P59 Delegation) Research to examine the use of Assistant Practitioners in the NHS in England, explore the benefits of their use, examine the barriers to their further implementation and identify ways in which Skills for Health can support their further introduction.
• The Cavendish Review (PDF) an Independent Review into Healthcare Assistants and Support Workers in the NHS and social care settings (2013, Health Education England)
• Care quality commission (CQC) The independent regulator of health and social care in England (reg. 12: Safe care and treatment)
• Special educational needs and disability code of practice: 0 to 25 years Statutory guidance for organisations which work with and support children and young people who have special educational needs or disabilities (Jan 2015)
• Allied health professionals: can we measure quality of care? – QualityWatch report
• Allied Health Professions into Action: Using Allied Health Professionals to transform health, care and wellbeing (PDF) 2016/17- 2020/21 (NHS England, Jan 2017)
• NHS England’s Five Year Forward View (2014)
• Commissioning Guidance for Rehabilitation London (PDF) (NHS England, 2016)
• A strategy to develop the capacity, impact and profile of allied health professionals in public health (PDF) (2015-18 London)
• The role of Allied Health Professionals in public health – examples of interventions delivered by allied health professionals that improve public health. (Public Health England, 2015)
• AHPs into Action NHS England
• Using Allied Health Professionals to transform health, care and wellbeing (PDF) 2016/17-2020/21, NHS England
• Supporting NHS providers to deliver the right staff with the right skills, in the right place at the right time: Safe sustainable and productive staffing (PDF). National Quality Board. (2016). London: Williams Lea.
• Allied health professionals are critical to new models of care. Oliver, D. D. (2015, Dec)

Policy Scotland

Here you will find links to relevant national legislation, policy and frameworks.

Please note that this list is not exhaustive. Please contact us to propose any additions.

Please note: the resources on this page are provided for informational purposes only. No endorsement is expressed or implied, unless otherwise stated. While we make every effort to ensure this page is up to date and relevant, we cannot take responsibility for pages maintained by external providers.

• Everyone Matters: 2020 Workforce vision (PDF) – Scottish Government 2013 Policy document to support the provision of safe, effective, person-centred care to enable everyone to live longer, healthier lives at home, or in a homely setting
• AHPs as agents of change in health and social care (PDF) The National Delivery Plan for the Allied Health Professions in Scotland, 2012 – 2015 AHP
• AHPs as agents of change in health and social care
• Getting it right for every child and Early Years Collaborative (GIRFEC) Scottish Government policy aimed to ensure that all Scotland’s children, young people and their families have consistent, co-ordinated support, when they need it.
• The Active and Independent Living Programme in Scotland 2017 (AILIP) a three year Allied Health Professions-led national improvement programme, which builds on the AHP National Delivery Plan 2012-2015. It aims to maximise the contribution that AHPs will make to the health and wellbeing of the population of Scotland.

Policy Wales

Here you will find links to relevant national legislation, policy and frameworks.

Please note that this list is not exhaustive. Please contact us to propose any additions.

Please note: the resources on this page are provided for informational purposes only. No endorsement is expressed or implied, unless otherwise stated. While we make every effort to ensure this page is up to date and relevant, we cannot take responsibility for pages maintained by external providers.

• Modernising AHP Careers in Wales, a Post-Registration Framework (2016). The framework sets out how organisations can be encouraged to introduce career advancement pathways that offer genuine development opportunities for the workforce, while ensuring this development meets future service demands.

Policy Northern Ireland

Here you will find links to relevant national legislation, policy and frameworks.

Please note that this list is not exhaustive. Please contact us to propose any additions.

Please note: the resources on this page are provided for informational purposes only. No endorsement is expressed or implied, unless otherwise stated. While we make every effort to ensure this page is up to date and relevant, we cannot take responsibility for pages maintained by external providers.

• Allied Health Professionals: Their role in healthcare reform and developing primary and community care. Research and information service briefing paper, Northern Ireland Assembly (Dr J Thompson, Nov 2016)
• Rethinking the Public Health Workforce 2015 – Royal Society for Public Health (RSPH)
• RQIA (Regulation and Quality Improvement Authority) – The RQIA was established in 2005 and is responsible for registering, monitoring and inspecting health and social care services in Northern Ireland, while encouraging improvement in their quality.
• Our Children and Young People – Our Pledge: A ten-year strategy for children and young people in Northern Ireland, 2017-2027.

References

• NHS England Allied Health Professions into Action: Using Allied Health Professionals to transform health, care and wellbeing. 2016/17- 2020/21
• Allied Health Professions Co-creating Wellbeing with the People of Scotland: The Active and Independent Living Programme in Scotland 2017
• Scotland: Health Care Support Workers (HCSW) Learning Framework 
• Wales: NHS Wales Skills and Career Development Framework for Healthcare Support Workers supporting Nursing and the Allied Health Professions
• England: Skills for Health
• Northern Ireland: Northern Ireland Social Care Council
• Support Worker Central