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This month we bring you a round-up of news impacting the world of complex care.
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The Care Quality Commission (CQC) has launched a consultation proposing changes to how it assesses and rates health and care providers. (Care Quality Commission)
They’re exploring:
A revised scoring model
More emphasis on professional judgment
Simplifying the rating process and keeping ratings more up to date
Over recent months, CQC has also published updates on its “Improving how we work” program—sharing what it’s heard from providers so far and clarifying next steps.
Inspection expectations may shift
Some criteria might become stricter, or new emphasis areas could emerge.
Do this: Review your current performance against the 5 CQC key questions (safe, effective, caring, responsive, well-led) and self-audit where your evidence is weakest.
Ratings may become more dynamic
Instead of static snapshots, ratings might be revisited more often or tied to ongoing data.
Do this: Ensure your systems are set up to capture real-time data and incident responses—don’t wait for an announced inspection.
Your voice matters
Because it’s a consultation, providers have an opportunity to shape the changes.
Do this: Engage with the consultation (or through trade bodies) and provide feedback based on your frontline experience.
Under the NHS’ new 10-year plan, there’s a move to require that 95% of patients with complex needs will have a personalised, co-created care plan by 2027. (Pulse Today)
Currently, only about 20% of people with long-term conditions have such a plan in place.
The goal is that these plans won’t only cover medical treatment, but also holistic needs—social, mental health, rehabilitation, daily living, etc.
Standard expectation is rising
Over the next 2 years, personalised care plans won’t be optional—they’ll be the benchmark.
Do this: Assess how many of your clients currently lack a fully integrated, holistic plan—and start bridging gaps now.
Stronger accountability & scrutiny
Commissioners and regulators will begin tracking adherence and quality of these care plans.
Do this: Document client involvement, plan updates, and measurable goals clearly—so it’s auditable.
Opportunity to influence system design
As the policy rolls out, feedback from case management will be critical to get it right.
Do this: Engage in local planning forums or stakeholder groups to shape how “personalised care” is defined and operationalised.
Lancashire and South Cumbria ICB has outlined its commissioning intentions for 2025/26, aiming to reduce spending and reconfigure services amidst a projected £350 million deficit. The focus is on prevention, delivering care closer to home, and leveraging technology. However, these financial constraints may lead to service reductions or delays in care delivery, impacting case managers coordinating complex care.
What this means for you:
Anticipate potential service limitations and delays. Proactively communicate with service providers to understand capacity and plan accordingly. Consider alternative care pathways and engage with multidisciplinary teams to ensure continuity of care for your clients.
The ongoing employment tribunal involving nurse Sandie Peggie and NHS Fife has garnered significant attention. Peggie alleges harassment and victimisation under the Equality Act 2010 after being suspended for objecting to sharing a female changing room with transgender doctor Dr. Beth Upton at Victoria Hospital in Kirkcaldy. The case raises questions about workplace policies concerning gender identity and single-sex spaces.
What this means for you:
Stay informed about workplace policies regarding gender identity and single-sex spaces. Engage in training and discussions to navigate these sensitive issues effectively. Ensure that your practice aligns with current legal standards and organizational policies to maintain a respectful and compliant work environment.
The government’s exploration of private investment to fund up to 200 new NHS neighbourhood health centres across England by 2035 signifies a shift towards integrated, community-based care. These centres aim to provide services closer to patients’ homes, potentially impacting case management strategies.
What this means for you:
Monitor developments in your region regarding the establishment of neighbourhood health centres. Engage with local commissioners to understand how these changes may affect service delivery and care pathways. Adapt your case management approach to incorporate new services and ensure seamless care coordination for your clients.
NHS Resolution reported resolving a record 83% of clinical claims without litigation in 2024/25, highlighting the importance of proactive risk management and communication in preventing complex cases from escalating into legal disputes. The Dash Review emphasizes the need for systemic improvements to enhance patient safety, integral to effective case management.
What this means for you:
Implement thorough documentation practices and maintain open lines of communication with all stakeholders. Engage in regular risk assessments and training to identify potential issues early. Collaborate with multidisciplinary teams to develop and implement strategies that mitigate risks and enhance patient safety.
The UK government has introduced significant reforms to enhance the accountability and professionalism of NHS management.
Key Reforms:
Implications for Case Managers:
The NHS Business Services Authority has begun developing a next‑generation platform to replace the Electronic Staff Record, designed to support recruitment, onboarding, career development, and workforce data management. This digital transformation aims to strengthen workforce planning and integrate staff information across health and care systems, improving visibility and coordination in complex care pathways.
Read more here.
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