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Complex Care

Champions receive training in one of six specialist areas:

  1. Dementia
  2. Nutrition
  3. Engagement and wellbeing
  4. Falls and fragility
  5. Wound management
  6. Health - including end of life, continence, neurological and respiratory conditions.


Q: How much is the Complex Care premium and what are the conditions of it being paid? 
A: Care homes are paid £70 per resident per week for those residents who meet the agreed criteria as a 'complex care' resident.

Q: What can care homes spend the Complex Care premium on? 
A: Homes can choose how they spend the extra money. Some choose to enhance the pay of staff who have opted for extra training, or to provide cover for staff on training courses. Some use the money to fund improvements such as extra staffing at mealtimes, dementia-friendly crockery and coloured toilet seats and light switches.  In other homes, new resources like laptops or electronic care plans have been purchased. 

Q: How was the Complex Care Premium calculated? 
A: The current day time staffing ratio within the 'fair cost of care' model is as follows:


Assumption within model


Care Assistant Staffing ratio (day)

Assumes staffing ratio of 1:6.5 in the day (12 hour shifts)

45 residents divided by 6.5 ratio = 7 staff x 12 hours x 7 days x £8.62ph divided by 45 residents = £112.63

If around 15% of residents may be eligible for the premium, that means of the 45 residents in the model, 37 are not eligible and 8 are. So: 

Rework the calculation above for 37 residents comes out as £111 per person per week for daytime care.

Re-do the calculation above for 8 residents at 1:4 care ratio = 8 residents divided by 4 ratio = 2 staff x 12 hours x 7 days x £8.62ph divided by 8 residents = £181.02

The difference between what’s in the model and what’s additional is therefore £181 minus £111 which is £70 pounds per person per week.

Since this model was agreed, we have been monitoring activity which could suggest a change to the above rationale.  For example, the Premium claim rate has generally been higher than that stated above, at about 29% of total residents.

Q: What do you mean by complex? 
A: Patients:

  • with more involved care conditions
  • who are not eligible for Continuing Health Care
  • who have been identified as having more than one of the illnesses or needs in the list below: 
  • Dementia
  • Falls Prevention
  • Nutrition
  • Wound Management
  • Health Care - end of life, continence, neurological and respiratory

Q: Does the care home need to have committed to staff training in all of your pathways to receive the payment? 
A: Care homes are paid £70 per 'complex' resident per week. There are different justifications for which a resident can be claimed as being 'complex' that are related to the Champion training pathways (e.g. ‘nutrition’ or ‘dementia’). In order to be eligible, the Champion trained in that particular area must be in place at the home at the time of the claim, otherwise the £70 payment will be rejected for that particular resident. This was more of an issue when the payment of the Premium began last October, before some of the Champion training pathways had been completed. Now it is just an issue if one of the Champions leaves, but Hertfordshire Care Providers Association and the CCG work with the home when this happens to try to get a new Champion trained as quickly as possible.

Case Studies

Mrs N has lived at St Andrews Care Home for 4 years. Upon arrival she was independent and mobile with the aid of a zimmer frame, living on the lower needs residential unit. As her condition deteriorated, she became less mobile and her dementia progressed to the extent of becoming fully reliant on staff to move. This worsened to the point of Mrs N being unable to bend her knees, causing a problem with the use of the wheelchair, as she was unable to put her feet on the footplates. Mrs N became very withdrawn and depressed through her limitations to visit friends and family and go into the garden, both activities that she enjoyed the most. 

Through the Enlight Physiotherapy course, I learned how to refer Mrs N to wheelchair services for a more suitable, accommodating wheelchair. This lead to Mrs N receiving a new wheelchair quickly and her attitude became much more positive as she was able to partake in the activities she enjoyed. It was lovely to see her talking about things she can now look forward to.

This was a service that I would not have known I could apply her for or know how to apply, prior to the course. The continual support I received from Suzy and Natalie at Enlight, was amazing and made such a difference.’

Mrs B is 96 years old and lives with dementia in one of our CCP care homes for 7 months. 

Due to certain events in Mrs B’s life that happened prior to her arrival at our home, Mrs B had only been consuming Ensure drinks and other milky drinks and she has refused to eat anything.  Carers efforts failed, and through Dietician referral, pro-call shots and other milky fortified drinks were being provided. 

The champion continued to encourage Mrs B everyday with different foods, sizes and plates until one day the champion presented Mrs B a small cup of soup. The carer then left the room to watch from a far and witnessed Mrs B drink all the soup in the cup! 

The champion / carer is now trying other things and recently Mrs B has started to drink melted ice-cream and full cream out of a cup and staff are now looking at whether we could liquidise her food so Mrs B may drink it from her cup.

The training provided the carer with confidence, it allowed her to try out new things and be imaginative and the resident has also gained weight. 

Mrs S is a 94-year-old and lives with Dementia. She has been with us since last year. Mrs S started to fall forward and out of armchairs resulting in head and facial injuries and wounds.  This was because of her leaning forward and falling asleep and then fall on the floor.

Carers encouraged Mrs S to have a foot stool to have her feet up on, however Mrs S did not like this as she found it uncomfortable. Carers would then place a table in front of Mrs S when she requested it, only to watch Mrs S lay her head on the table and go to sleep, when aided to go to bed for a nap Mrs S always declined, insisting she was not sleeping.

Through internal discussions and consulting with the Family, the care home decided to trial Mrs S in a recliner armchair to see if this would prevent falls and make an improvement in her day to day living. Mrs S loves the recliner. She has had no more falls. This has led to a reduction in falls and injury to Mrs S.

This simple adaptation and management has led to improved satisfaction, better care for the resident, communication within the team and the family.   

Mr A was admitted to Pinelodge with a Grade 2 and Grade 4 pressure sore, he was bedbound but non-compliant with SALT and the Dietician Team.

Lorna worked closely with Mr A to build up rapport and engage with his family. After a discussion with Mr A’s family, Lorna was able to establish the nutritional food groups that Mr A liked the most and encouraged the family to bring in snacks. This led to Mr A consuming more food and even lead to a weight increase.

Lorna was able to work alongside the Nutrition Champion in order to build a Food and Fluid chart that Lorna could evaluate alongside wounds and healing. This helped identify how nutritional intake could benefit wound healing and help provide better care. Both of Mr A’s wounds were healed.

Each service user has a body map on admission as well as a close monitoring of nutritional intake. The Champions are then able to use this information and current evaluations to devise a new body map for senior nurses to clearly identify the ‘at risk’ pressure areas. By keeping this information accessible in the hand over, pre-empting risks becomes much more manageable.

Service User had been admitted to Pinelodge with recurrent chest infections, have 5 in the last couple of months. They had a history of Asthma and Pneumonia; as well as non-compliance with interventions to reduce his chest infections.

The Health Champion made a referral to the Respiratory Team who implemented the following recommendations:

  • Advised to monitor average saturation throughout the day
  • Provide an Oxygen Chamber to administer his inhaler
  • He was referred and provided with a Nebuliser Machine

The Respiratory Team worked alongside the Health Champion and Service User to promote and educate around the importance of the above and from February this year, this service user has experienced zero chest infections.

A Service User with Dementia had been admitted to Pinelodge following their discharge from a Mental Health Unit where they had been sectioned for their behaviour. Upon admission to Pinelodge, this service user would refuse to get into bed; spit out tablets and decline any support.

The Dementia Champion was able to liaise with the Community Mental Health Team, as well as family members, which allowed them to apply a key worker to provide personal care in order to build a rapport and trust. Since the review of his needs and an increase in family, that built recognition with familiar faces, a vast improvement with co-operation, medicine consumption and the engagement with others. ‘Without the Dementia Champion being available in their role, the team may have found it too difficult to attempt to manage and meet his needs.’