To ask the Minister of Health to detail any measures his Department currently implements to ensure those who require feeding or medication via a percutaneous endoscopic gastrostomy tube can access Health and Social Care Trust-employed carers who are permitted to carry out such care.

My department has sought answers from the five HSC Trusts in relation to their current processes, please see their responses below: -

Belfast Trust

Children’s Community Nursing (CCN) currently have approximately 80 children on caseload requiring PEG feeding. The CCN team support families with provision of required equipment/feeding sets but do not provide carers to administer enteral feeds and medication. As a rule, parents assume this role and receive the requisite training before their child is discharged from hospital. Parents, if eligible, can also use Direct Payments to facilitate additional support. The CCN team can provide training and order equipment for these specific clients.

Northern Trust

Across the programmes of care there a number of pathways to ensure those who require feeding or medication via a percutaneous endoscopic gastrostomy tube have their needs met.

With respect to children with a disability, the Trust has a ‘children with a disability’ resource panel. An Understanding the Needs of Children in Northern Ireland (UNOCINI) is completed in respect of any child being presented at panel (which will include recommendations in terms of level of care (hours) and which service will undertake that support including any delegated nursing tasks, such as PEG feeding.

If it is a child with complex physical healthcare needs the UNOCINI is also supported by a CMAC (Comprehensive Multidisciplinary Assessment of the Child) – coordinated by the paediatric discharge transitions coordinator.

In adult services, PEG feeds and PEG medications following an assessment of need are generally outsourced as per the Delegation of Nursing Tasks to Independent Service Providers & Protocol for Accessing Enhanced Packages of Care policy.

Within Adult Learning Disability Services, people who require feeding or medication via a percutaneous endoscopic gastrostomy (PEG) tube will have an assessment of their need completed; this informs a determination regarding which service will undertake that support including any delegated nursing tasks. For those individuals attending Trust supported living, short break or day centres PEG feeds (and medication) are available through Trust trained care staff; and for others this may be through commissioning with the independent sector.

South Eastern Trust

Service users who require feeding or medication via a Percutaneous Endoscopic Gastrostomy tube (PEG) will have an individual patient risk assessment completed by the relevant community nursing team.

This will determine best interest and if agreed; who is best placed to support the use of the Percutaneous Endoscopic Gastrostomy tube for medication and/or feeding. The individual could be the service user themselves, a family member, a carer; a Health and Social Care Trust (HSCT) employed carer or a classroom staff member; identified by an individual school.

A programme of education is delivered by the relevant community nursing team. This will include demonstration and observation of the skills required to safely administer the prescribed feed and medications.

The competency base training is underpinned by competency documentation alongside wrap around support; on any ongoing concerns or queries; by the relevant team engaged in the delivery of training.

Southern Trust

There are currently 76 children and young people with gastrostomy devices, (including percutaneous endoscopic gastrostomy tubes) on Community Children’s Nursing (CCN) caseloads, that require feeding and/or medication. The CCN service provides respite to a total of 35 children and young people with gastrostomy devices where an identified need has been assessed. CCN Healthcare Workers are trained to carry out this care through the CCN Competency Training Process and Guidelines for CCN Healthcare Workers and Carers and Northern Ireland Practice & Education Council for Nursing & Midwifery (NIPEC) Delegation Decision Framework (2019).

Western Trust

The Western Health and Social Care Trust do not delegate nursing tasks to health care workers that include the administration of medications via a PEG tube, as this remains a nursing health care task and not a social care task. The Trust however, does train some staff to assist with the stopping, starting, disconnecting and re-connecting of the tube for personal hygiene and hoisting needs.

The area of delegation of health care tasks to Personal Assistants and/or care workers is currently being reviewed by the Chief Nursing and Social Work offices and my hope is that the outworking’s of this will give a clearer regional position on delegated health care tasks.