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Complex Care – What Is It, And What Does It Involve?

George Griffiths

10 July 2021

Complex Care – What Is It, And What Does It Involve?

George Griffiths

10 July 2021

Complex care nursing is increasingly recognised as being vital for supporting people with a range of health and social needs. 

Many patients in care homes, outreach service users, vulnerable people, and those living with chronic conditions have varied needs. They don't require just one standalone medical support network or treatment to live the best quality of life.

Creating an excellent care plan means looking at all sorts of factors, such as:

  • Clinical support needs
  • Nursing requirements or domiciliary care
  • All health conditions
  • Primary and secondary health factors

In this guide, we’ll explain what complex care means, how that relates to social care and nursing, and how vast the range of needs can be.

What is complex care?

Complex care means that an individual will receive tailored support from specialised nursing teams. These teams combine different treatments and support to help them live well.

You can find complex care nursing wards in hospitals, and outreach teams supporting people in the community. There are also complex care consultants assessing whether care provision meets the proper standards.

We've written before about person-centred care; it's something that should be at the heart of all healthcare services, whether public NHS medical treatments, private therapy or in care homes.

Person-centred means that the care plan for a person with these needs isn't a standard template. 

Instead, their complex care team will assess a range of social, behavioural and medical challenges to create a cohesive response that will fit their needs.

What is complex care in nursing?

Living with a long-term health condition or managing a serious illness can have wide-reaching impacts on a patient's mental health and life experiences.

Treating the condition itself is often just a fragment of the broader picture.

Complex care nursing teams look to enrich people's lives by addressing their needs in a friendly, approachable way.

For example, nurses might provide:

  • Help with nutrition, exercise, mobility and speech
  • Domiciliary care to help people with washing and taking their medication
  • Support with learning difficulties, mental health issues and respiratory difficulties

Complex care is also called continuing care. It can vary from providing airway management to help someone who struggles with respiration, to helping with physiotherapy for somebody with a spinal injury.

What are complex care needs?

There isn't any one set of circumstances that requires input from a complex care team, but examples include:

  • People with spinal injuries or brain injuries following an accident
  • Patients with a neurological condition or mental health issue
  • Those with learning difficulties or severe mobility issues
  • Individuals with airway problems or respiration disorders

Complex care nursing also comes in many different guises. 

You might have a team that coordinates support for a person in their own home or a residential nursing environment.

In some cases, the local authority will also fund this support based on means-testing. 

You can discover more information about financial support for NHS continuing healthcare through their online portal.

What are the aims of a complex care team?

The team will look to meet several key standards, ensuring that each person receives bespoke care plans.

Complex care should be:

  • Person-centred: based on the individual, their strengths, aspirations, family support network and daily schedule
  • Fair and accessible: available equally to all people, with structures to help those with barriers to seeking support gain the assistance they need
  • Coordinated across sectors: teams break down communication gaps to bring groups of professionals together providing whole-person care
  • Team-based: include teams of medical practitioners, social services and behavioural health professionals to succeed, all working together and guided by the wishes of the individual
  • Guided by data: given the teamwork aspect of complex care, partners must share data across their networks, evaluating success and ensuring they effectively support the person's goals
complex care

How does the NHS assess people's needs?

If a person requires help from a complex care nursing team, the first step is to request an assessment for continuing care through the NHS Clinical Commissioning Group (CCG).

Those initial assessments can be carried out by a social worker, nurse, healthcare professional or doctor. This must be done with the patient’s consent and understanding that they are being assessed for complex care needs.

The individual is then referred for a full assessment where the initial evaluation meets the criteria for complex care nursing.

You can access the checklist used in this initial complex needs assessment through the Department of Health and Social Care.

Full NHS complex needs assessments

A multidisciplinary complex care team should include at least two professionals from different healthcare professions.

They will look at the initial assessment and consider needs such as:

  • Medications, cognition and mobility
  • Emotional and psychological needs
  • Behaviour, breathing and nutrition
  • Continence, skin and communication

Each factor carries a weighting, so it's clear that if several priority markers are assessed, a person requires this support.

People who have a severe need in one area, and several more minor requirements, will also qualify for NHS complex care nursing.

Finding a care home for complex needs

Depending on their conditions and abilities, many individuals with complex needs will live in a residential setting or care home.

Others will prefer to live at home, receiving domiciliary care through a community nursing network.

If you have a relative in a care home assessed for this care, it can be confusing to establish the right course of action.

The CCG will typically refer people with these needs to a nursing home rather than a care home. 

These facilities have a qualified nurse on duty. They can accommodate individuals with complex medical conditions, severe learning or physical difficulties.

After an NHS assessment, the CCG will then determine whether an existing care home has the right staff and resources to meet the person's individual needs.

Moving can be emotionally distressing, so the CCG will only recommend a move when necessary.

You can always have a say in your choice of nursing or care home. The person with complex needs can decide where they feel most comfortable.

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