Head of Nursing- Complex Care in Surrey

1. PURPOSE OF THE ROLE

Unicares complex care division delivers nursing interventions in peoples own homes under the regulated activity of Treatment of Disease, Disorder or Injury.

The people we support depend on that care being clinically correct every time: a tracheostomy mismanaged, a ventilator alarm misread or a rescue medication given late has immediate and irreversible consequences.

The Head of Nursing holds professional and clinical accountability for that practice.

The postholder sets the clinical governance framework for the division, owns the competency and delegation architecture on which safe delivery depends, assures that clinical standards are met in every package, and provides the professional line for the registered nurses delivering it.

The post reports directly to the Chief Executive Officer so that clinical objection to a commercially attractive package is heard at the level where the decision is made.

This is not an operational management post.

The authority of the role is professional, not managerial, and rests on clinical credibility, evidence and the direct line to the Chief Executive.

2. ORGANISATIONAL CONTEXT

Unicare Complex Care Specialist Ltd is a CQC-registered, nurse-led provider operating nine supported living services and community outreach across Surrey, Sussex, Berkshire and South London, and registered for Treatment of Disease, Disorder or Injury.

The complex care division delivers nurse-led and nurse-delegated clinical care to adults and children in their own homes, including tracheostomy care, invasive and non-invasive ventilation, enteral feeding, suctioning and oxygen therapy, seizure and rescue medication management, bowel care, catheter and stoma care.

A substantial part of the divisions registered nursing capacity is engaged through contracts for services rather than employment.

The clinical governance framework must therefore hold consistent standards across a workforce that is not uniformly employed a defining challenge of this post and a point on which CQC will test us.

• Scope and boundaries
• To avoid ambiguity between senior clinical roles, the following boundary applies:

In scope: all nursing and nurse-delegated clinical practice within the complex care division; clinical governance, competency and delegation for that practice; clinical assessment of complex care referrals and packages; and the clinical content of complex care training.

Out of scope: mental health nursing practice, restrictive practice reduction and Positive Behaviour Support, which sit with the Head of Mental Health Nursing.

Operational management of services, staffing and rota delivery sits with the Head of Care.

Commercial negotiation of package rates sits with the business development function, informed by this posts clinical assessment.

Where a person we support has both complex physical health and mental health needs, the postholder and the Head of Mental Health Nursing are jointly responsible for an agreed, documented clinical position.

• 3. KEY RESPONSIBILITIES
• Clinical governance and assurance
• Design, own and maintain the clinical governance framework for the complex care division: clinical standards, policies, procedures, audit programme, clinical incident review and learning from serious incidents.
• Run a rolling programme of clinical audit and package-level quality review, report findings and required actions to the Chief Executive and Board, and evidence what changed as a result.
• Maintain the clinical assurance evidence required by CQC, ICBs, commissioners and safeguarding partners, and represent Unicare clinically during inspection and quality visits.
• Lead clinical incident review and, where the threshold is met, serious incident investigation, ensuring the duty of candour is discharged and actions are tracked to completion.
• Provide the Chief Executive with an independent clinical view of risk, including where it differs from the operational or commercial position.
• Competence, delegation and the unregistered workforce
• Own the competency framework for every delegated clinical task, defining what competence means for each intervention, how it is assessed, how often it is reassessed and what triggers its withdrawal.
• Set the professional standards under which registered nurses delegate clinical tasks to Healthcare Assistants and Support Workers, and assure in practice that delegation, supervision and accountability are correctly distinguished and correctly recorded.
• Assure that no delegated clinical task is carried out by a person whose competence for that specific intervention, for that specific individual, has not been assessed and signed off.
• Maintain a live, auditable record of competence across the division that can be produced on demand.
• Provide professional direction to the complex care clinical training function, including curriculum content, clinical accuracy and the standard required to pass.
• Professional leadership of the nursing workforce
• Act as the professional line for all registered nurses delivering complex care under Unicares registration, whether employed or engaged under a contract for services, in each case working within the terms of their engagement.
• Assure, before any nurse works on a Unicare package, that NMC registration is current and unrestricted, that professional indemnity arrangements are in place, and that clinical competence for the relevant interventions has been evidenced.
• Establish clinical supervision and professional support arrangements appropriate to the workforce model, with documented frequency, content and escalation routes.
• Handle professional practice concerns and fitness to practise matters, including the decision to remove a nurse from a package and any referral to the NMC.
• Advise the Chief Executive where the workforce model itself creates clinical governance risk, and propose the remedy.
• Referrals, packages and clinical delivery
• Provide the clinical assessment and opinion on complex care referrals, including whether Unicare can safely staff and sustain the package, and advise the Chief Executive where a referral should be declined.
• Set the clinical readiness criteria a package must satisfy before it goes live, including care planning, competency sign-off, equipment, emergency planning and family involvement.
• Assure the quality of clinical care planning, risk assessment, emergency and contingency plans, and end of life or advance care planning where relevant.
• Own clinical standards for medicines management in the home, including controlled drugs, rescue medication and administration by trained unregistered staff.
• Set standards for recognising and escalating clinical deterioration, and for the response where emergency services are distant.
• Lead the clinical response where a package is destabilising or has failed, and conduct the clinical review afterwards.
• Legal, regulatory and safeguarding
• Assure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 across all complex care delivery, in particular Regulation 12 and Regulation 20.
• Assure the correct application of the Mental Capacity Act 2005 and, for children and young people, of consent, parental responsibility and Gillick competence.
• Provide senior clinical input to adult and childrens safeguarding enquiries and act as a clinical point of contact for safeguarding partners.
• Keep the Chief Executive and Board briefed on clinical, regulatory and guidance change affecting complex care, and lead the operational response to it.
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