Complex Care Mobilisation: From Referral to Safe “Day 1” Delivery at Home
Complex care packages often arrive with urgency: a hospital wants to discharge, a family is struggling, or a commissioner needs an alternative to an inpatient bed. The risk is that “speed” replaces “safety”. A strong mobilisation process protects the person, the commissioner and your organisation by making sure the basics are right before Day 1.
Related Knowledge Hub tags you may find useful: Service Models & Care Pathways and Risk Management, Safeguarding & Lone Working.
Why mobilisation matters in complex care
Many quality failures in complex homecare are not “delivery failures” — they are mobilisation failures. Common examples include:
- Starting without an agreed escalation plan or clinical oversight
- Incomplete information from hospital discharge summaries
- Equipment not in place (or staff not trained to use it)
- Care plans copied from generic templates without person-specific thresholds
- Staff allocated based on availability rather than competence
A mobilisation pathway turns these predictable risks into a controlled checklist.
Stage 1: Referral triage and acceptance decision
Start with a structured triage call (commissioner, hospital discharge team, family where appropriate). Capture:
- Clinical tasks required: what is being delegated and what is not
- Risks and triggers: recent deterioration, infections, falls, aspiration, skin breakdown
- Environment: access to the home, storage for equipment, space for hoists, power supply
- Capacity and consent: decision-making, best interests if needed, who can consent to care
- Safeguarding flags: concerns, family stress, self-neglect, domestic risks
Commissioners expect an honest “no” where the risk is outside your competence or cannot be managed safely at pace.
Stage 2: Initial risk screening and mobilisation plan
Before accepting, create a short mobilisation plan that sets the route to a safe start. This should include:
- What information you need (discharge summary, medication list, therapy notes)
- Who is providing clinical oversight (named lead and contact route)
- Equipment requirements and who is responsible for delivery
- Staffing model (hours, doubles, waking nights, continuity expectations)
- Start date conditions (what must be in place before Day 1)
This is a practical, commissioner-friendly document: short, clear, and focused on risk control.
Stage 3: Assessment visit and environment check
Where timelines allow, complete a pre-start assessment in the home. In complex care, the environment often creates hidden risk. Check:
- Safe moving and handling routes (stairs, narrow doors, uneven floors)
- Infection prevention needs (waste disposal, hand hygiene, clean storage)
- Medication storage and controlled drug requirements where relevant
- Equipment placement, power points, and contingency for failures
- Privacy and dignity considerations for personal care tasks
If a visit is not possible before start, make Day 1 a “stabilisation shift” with a senior lead present and a same-day review.
Stage 4: Staffing — competence, continuity and cover
Commissioners value continuity in complex care because it reduces risk. Operationally, you need:
- A core team: small group trained and signed off for the package
- Cover plan: named cover staff with the same competencies
- On-call readiness: managers know the package and escalation guidance
A practical technique is to allocate “mobilisation shifts” (shadowing or paired shifts) before staff work alone in the package.
Stage 5: Documentation that enables safe delivery
Before Day 1, you should have (as a minimum):
- Person-specific care plan with clear instructions and thresholds
- Risk assessment that links directly to support strategies
- Escalation pathway (including out-of-hours contacts)
- Medication information and delegation guidance where applicable
- Consent documentation and information sharing permissions
The test is simple: could a competent staff member pick up the folder and know what to do at 2am when the person deteriorates?
Stage 6: Day 1 safety checks and commissioning checkpoints
Day 1 should be treated as a controlled start, not “business as usual”. Build in:
- Senior oversight: a manager check-in within the first shift
- Staff confidence check: do staff understand the plan and escalation triggers?
- Family alignment: confirm expectations and communication routes
- Commissioner update: confirm start has happened safely and note any gaps
Commissioners often value brief, proactive updates during mobilisation because it reassures them that risk is being managed rather than ignored.
Stage 7: First-week review and stabilisation
The first week is where you identify whether the package is stable. Build a review point at 72 hours and at 7 days:
- Review incidents/near misses and adjust the plan quickly
- Check records quality and whether staff are escalating appropriately
- Confirm equipment is working and used correctly
- Agree any changes with the commissioner and document them
Strong providers treat mobilisation as a process, not an event. That’s what reduces risk and builds commissioner confidence long-term.