There’s a persistent assumption in complex care: that beyond a certain clinical threshold — ventilation, tracheostomy, unstable epilepsy — home stops being an option. In our experience, the threshold isn’t clinical at all. It’s organisational. With the right model behind it, hospital-level care can work at home — and work well.

This piece is for the professionals who commission and refer into complex packages — and for families who’ve been told “that’s too complex for home care.”

The range of what we support

Across Wales, our teams support people with tracheostomies, invasive and non-invasive ventilation, PEG and enteral feeding, suctioning, complex epilepsy with emergency medication protocols, and the layered health needs that often come alongside a complex learning disability or autism. Round-the-clock packages and two-to-one support are routine parts of our work, not exceptions to it.

How nurse-led delegation actually works

The question that matters isn’t “can a support worker do a clinical task?” — it’s “who decided they were competent, and who keeps checking?” In our model the answer is specific and accountable:

A named nurse assesses the package before support starts — the tasks involved, the risks, and what competence looks like for this person’s needs, not a generic checklist.

Training is tailored, then formally assessed. PAs are trained on the specific person’s equipment, protocols and baselines. Nothing is delegated until our nurse has signed off competency — and delegation is to a named PA for a named client, never transferable by default.

Oversight doesn’t stop at sign-off. Competencies are reviewed on an ongoing cycle, refreshed when anything changes — equipment, medication, presentation — and revoked if standards slip. Clinical accountability stays with the nursing team throughout.

It’s the same delegation framework used in NHS community nursing, applied rigorously in a domestic setting, under CIW registration.

Why this matters to commissioners

Continuity is designed in. Because clients choose their teams — often people from their own community — turnover on our packages is low, and every avoided handover is avoided clinical risk. We wrote about that principle in Local People Supporting Local People.

Escalation is clear. Families and PAs know who to call, and a nurse who already knows the package answers. Small concerns get dealt with before they become admissions.

The package flexes without re-procurement. Needs change; the same team retrains and the plan adapts, with the clinical governance already in place.

What a referral looks like

There’s no referral form to wrestle with. A phone call or a message through our contact form reaches a person, not a queue; one of our clinical team will come back to you promptly to talk through the case — needs, risks, funding position, timescales — and give you an honest view on fit and feasibility. If it progresses, our nurse leads the assessment and works alongside your MDT from there.

Talk to our clinical team

If you’re a commissioner, social worker or clinician with a complex case — including packages that have struggled elsewhere — we’re happy to have a frank conversation about whether our model fits. Contact us via our contact form or on 0345 061 9000 and ask for the clinical team.

News & Updates

Delivering Complex Clinical Care at Home: Ventilation, Tracheostomy and Beyond