Skills for Care

How delegating healthcare activities to my PAs has changed my life

24 May 2023

5 min read

Rob Moriarty

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Rob employs personal assistants (PAs) to support him. He tells us how having healthcare activities delegated to his PAs has made his life better.

Delegated healthcare activities have given me the freedom to live my life with greater choice, flexibility, and control.

I have a high-level spinal cord injury as a result of a diving accident on holiday 25 years ago.

Since then, I’ve been drawing on care and support, including hiring my own team of PAs. But over the past nine years I’ve had a personal health budget which has allowed healthcare activities previously carried out by nurses or other medical staff to be delegated to my PAs to carry out for me instead.

This has completely transformed not only the way my care is delivered, but my whole life.

When I first started drawing on care and support, after leaving the hospital the district nurse would visit me at home every alternate evening to carry out activities such as bowel care and changing my catheter.

The visits were scheduled to be anytime from 6pm to 10pm but could sometimes be as late as 2 or 3am.

This was very restrictive on my lifestyle as I had to be at home every other evening waiting for the nurses to arrive.

The unpredictability of the timing of these visits also impacted on what I could eat.

The irregularity of when I was going to the toilet was also increasing the chances of a side effect of my spinal cord injury called autonomic dysreflexia which is a life-threatening condition if it isn’t treated promptly.

It was at that point really where I felt that things needed to change.

So, I got in touch with my main district nurse, and I told her that we needed to explore alternative options. She was really helpful in looking into what else could be offered to support me.

From her research she came back to me and told me about an irrigation system (a system which helps to empty my bowels) that was new in the UK at the time, that we could try it and see if it worked for me, and if so, my PAs could then be trained to use it.

This would mean that my PAs could support me with all of my healthcare activities as part of their daily routine and I wouldn’t have to be reliant on district nurse visits.

Luckily it worked for me, and my PAs all happily agreed to get trained on using the system. I've never wanted to ask them to do anything that they've been uncomfortable doing with this delegated health care activity or any other aspect of my life. They could see the benefits of it to me, but also to them in terms of their job on a daily basis.

This was the start of delegating healthcare activities to my PAs.

Using this system allows me to go to the toilet more regularly, which is better for my health. It’s also more efficient and time-saving. Previously it would take up to two hours to complete the process but it’s now around 20 minutes in the morning.

I now have complete flexibility to do what I want, when I want, whereas before I was quite limited as I had to be home on set evenings.

This allows me to do work at the university and with NHS England and enjoy my spare time.

There are health benefits to using the system. It keeps my bowels emptier and I’m far more comfortable now; I eat better, drink better and sleep better. I sit in less pain for longer and I take fewer medications.

The key benefits of delegating these healthcare activities to my PAs are that they can be far more responsive in terms of meeting my needs when they need to be met rather than me having to wait for the district nurses.

Above all the most important benefit for me is that I can work more productively and go out and do things every day if I want to. I’d say I’ve been able to quadruple the amount of work that I could do over the last few years as a result of the delegation and that's been of massive benefit to me. It’s not just a physical benefit, but socially, professionally and mentally too.

I can go on holiday without having a professionally trained nurse with me, and do things I love such as going to live comedy shows, sports matches, and music gigs.

The delegation of healthcare activities to my PAs also benefits them. It’s allowed them to develop new skills in their career and they feel they’ve been invested in. It gives them transferable skills that they can take forwards with them.

I’d say that for most of my PAs their confidence has increased throughout this process. It’s meant they don’t feel useless waiting on a nurse arriving, instead they can support me themselves.

This also means that nurses are available to spend more time with other people who do need or want that regular input from their district nurse.


Hear more from Rob about how his PAs carry out delegated healthcare activities in our video interview with him.

Find out more about delegated healthcare activities on our webpage.

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