Complex Needs & High-Dependency Care Insurance

Specialist insurance for domiciliary providers delivering complex, high-dependency and 24/7 care in the community.

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Support for providers delivering complex packages, high clinical input and intense staffing levels.

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We compare quotes from leading UK care sector insurers

  • Allianz
  • Aviva
  • QBE
  • RSA
  • Zurich
  • NIG

INSURANCE FOR COMPLEX & HIGH-DEPENDENCY HOME CARE PACKAGES

Insurance Built Around Complex Community-Based Care

Complex and high-dependency care in the community is very different from low-level support or traditional home help. You may be supporting ventilated adults and children, PEG-fed clients, people with acquired brain injury, spinal cord injury, profound learning disabilities, autism, behaviours that challenge, mental health conditions or a mix of all of these.

Insure24 works with insurers who understand complex needs and high-intensity packages. We help build policies that reflect your enhanced clinical risk, staffing ratios, 24/7 rotas and contractual requirements with NHS commissioners, ICBs and local authorities.

What Is Complex Needs & High-Dependency Care Insurance?

It’s a tailored insurance arrangement for domiciliary care providers whose packages involve complex clinical tasks, intensive staffing, higher physical/behavioural risk and often multi-agency involvement. It usually brings together:

  • Public Liability – for injury or property damage to service users and others during care.
  • Employers’ Liability – for injury or illness to staff delivering complex care tasks.
  • Medical Malpractice / Treatment Risk – for errors in clinical or personal care.
  • Professional Indemnity – for care planning, assessments, documentation and clinical governance.
  • Management Liability – for directors and managers making strategic and HR decisions.
  • Property & Office Insurance – for your premises, contents and equipment.
  • Business Interruption – where appropriate, for loss of income following insured disruption.
  • Cyber & Data – for breaches involving highly sensitive health records (where available).
  • Abuse Cover (where available) – subject to insurer appetite and robust safeguarding.
  • Extensions to recognise live-in care, waking nights and rapid-response services.
  • Cover limits aligned with NHS, local authority and case-manager contract requirements.
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Typical Complex Needs & High-Dependency Services We See

Every package is different – but many involve a mix of the following needs and interventions.

Clinical & Physical Complexity

  • Tracheostomy care and suctioning (within scope and with appropriate training).
  • Ventilation support, oxygen therapy and respiratory monitoring.
  • PEG/PEJ feeding, enteral nutrition and complex medication regimes.
  • Spinal cord injury, acquired brain injury and neurological conditions.
  • Seizure management and epilepsy care, including rescue medication.
  • Hoisting, transfers and full assistance with moving and handling.

Learning Disability, Autism & Behavioural Complexity

  • Support for people with profound and multiple learning disabilities.
  • Autism spectrum conditions requiring structured environments and routines.
  • Behaviour that challenges, including potential aggression or property damage.
  • Mental health conditions with fluctuating risk and crisis planning.
  • Community reablement and supported living-style high-dependency packages.
  • Safeguarding-sensitive environments and multi-agency case management.
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Who Is Complex / High-Dependency Care Insurance For?

Examples of providers and models where specialist, complex-friendly cover becomes important.

Domiciliary Care & Home Care Agencies

  • Agencies providing complex care within service users’ own homes.
  • Providers delivering mixed complexity – from standard to very complex packages.
  • Services commissioned by ICBs, NHS continuing healthcare or local authorities.
  • Providers supporting both adults and children with complex needs.

Live-In Care & 24/7 Rotational Teams

  • Live-in care providers delivering high-dependency, one-to-one support.
  • 24/7 packages with waking nights, double-up calls and rapid-response cover.
  • Providers supporting discharge-to-home arrangements from hospital.
  • Teams built around individual, bespoke complex packages.

Learning Disability & Autism Services at Home

  • Community-based support for people with learning disabilities and autism.
  • Complex behavioural support including PBS (positive behaviour support) approaches.
  • Providers supporting people transitioning from in-patient or residential settings.
  • Services working closely with multidisciplinary health and social care teams.

Case-Managed & Direct Payment Packages

  • Providers engaged by case managers, solicitors or deputies on complex cases.
  • Direct payment / personal health budget packages with formal provider contracts.
  • Providers working under detailed service specifications and outcome plans.
  • Services with significant manual handling, transport or community access risks.
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Why Use Insure24 for Complex Needs / High-Dependency Care Insurance?

Sector Knowledge & Realistic Conversations with Insurers

  • Understanding of complex care language, risks and commissioning frameworks.
  • Ability to explain your training, governance and risk management to underwriters.
  • Experience placing cover for providers with complex and high-risk caseloads.
  • Support where standard “low-risk” care markets don’t fit your service.
  • Realistic dialogue if you have historic claims or high-risk packages.

Cover Aligned to Contracts & Regulation

  • Policies designed to meet commissioner and contract requirements where possible.
  • Clear documentation for CQC, case managers and NHS partners.
  • Support in checking insurance clauses in tenders and service specifications.
  • Options for higher limits where contracts require them (subject to insurer appetite).
  • Ongoing support as packages and caseloads evolve over time.
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How to Arrange Complex Needs / High-Dependency Care Insurance

Key Information We Usually Ask For

  • Overview of your services and typical complexity of packages.
  • Breakdown of caseload by type (clinical complexity, LD/autism, behaviour that challenges, etc.).
  • Staff numbers, wage roll and skill mix (HCAs, RNs, support workers, specialists).
  • Details of clinical tasks undertaken and training/competency frameworks.
  • CQC/inspection ratings and any conditions or improvement actions.
  • Historic claims information and any serious incidents or inquests.

Our Approach to Complex Care Providers

  • We listen to how your service actually works – not just what a form suggests.
  • We help you present governance and risk management in a structured way.
  • We approach markets with genuine appetite for complex community care.
  • We compare options and explain differences in plain language.
  • Once agreed, we put cover in place and provide documents for commissioners and regulators.
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Risk Management & Clinical Governance for Complex Care Providers

Good governance supports safer care, stronger contracts and a better insurance outcome.

Clinical & Operational Controls

  • Clear clinical governance structure with defined accountability.
  • Robust assessment, care planning and review processes.
  • Competency-based training and sign-off for complex clinical tasks.
  • Medication management policies including high-risk medicines.
  • Incident reporting, root cause analysis and learning loops.
  • Regular multidisciplinary reviews for high-risk packages.

Workforce, Safeguarding & Governance Documentation

  • Safer recruitment, DBS checks and reference processes.
  • Supervision, appraisal and reflective practice for staff.
  • Safeguarding policies aligned with local and national guidance.
  • Lone working procedures and on-call escalation routes.
  • Information governance and secure handling of clinical records.
  • Clear documentation that can be shared with insurers and commissioners.
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“We specialise in complex, high-dependency packages. Insure24 helped us find insurers who understood our governance and could support the level of clinical risk we manage at home.”

Registered Manager, Complex Domiciliary Care Provider

UNIQUE INSURANCE
TAILORED FOR YOUR COMPLEX & HIGH-DEPENDENCY CARE SERVICE

SUPPORTING THE MOST COMPLEX PEOPLE SAFELY AT HOME

  • Protect your organisation while delivering highly complex care in the community.
  • Reassure commissioners and families that you have the right insurance in place.
  • Back up strong clinical governance with appropriate financial protection.
  • Build a platform for sustainable growth in complex and high-dependency packages.
  • Free leadership time to focus on quality, outcomes and staff support.
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FREQUENTLY ASKED QUESTIONS

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What counts as “complex needs” or “high-dependency” for insurance purposes?

There’s no single definition, but insurers generally view packages involving invasive clinical tasks, intensive staffing, significant behavioural risk or high levels of physical dependency as “complex” or “high-dependency”. This can include ventilation, tracheostomy care, feeding tubes, brain or spinal injury, profound learning disabilities and behaviour that challenges. We’ll talk through your caseload and help position it clearly for underwriters.

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Can I still get cover if we support very high-risk service users?

Often yes, but it depends on the detail: your governance, training, staffing levels, incident history and contract arrangements. Some insurers may decline, while others specialise in complex community care. Our job is to present a fair, accurate picture of your service and seek out insurers with appropriate appetite.

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We already have domiciliary care insurance – do we need something different for complex care?

Possibly. Some policies are designed around low- to moderate-risk support and may not fully reflect complex clinical tasks or high-dependency packages. It’s important that your insurer understands what you actually do. We can review your existing policy against your current caseload and advise whether changes or a different market are needed.

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Will complex needs insurance cover the clinical tasks we perform?

It should, but only if those tasks are clearly declared and within the agreed scope of practice. We’ll ask about the clinical interventions your staff carry out and ensure the policy wording, exclusions and endorsements match those activities. It’s important not to assume that “standard” care wording automatically includes complex clinical work.

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How does our CQC rating affect our insurance options or pricing?

Insurers may look at CQC reports as one indicator of governance and quality. “Good” and “Outstanding” ratings can support a positive view of your risk, while “Requires Improvement” or “Inadequate” may prompt more questions. What matters most is the story behind the rating and what you’ve done in response – we can help you explain that to underwriters.

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Can we get higher limits to meet NHS or case manager contract requirements?

Often, yes – subject to insurer appetite and the nature of your work. Many complex providers are asked for higher limits on public liability, malpractice or professional indemnity. We’ll review the specific contract clauses and discuss what’s realistic in the market, then look for solutions that come as close as possible to those requirements.

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What if we are expanding into more complex cases – when should we review our cover?

Ideally before or as you start to accept more complex packages, rather than waiting until renewal. Significant changes in case mix, clinical interventions or staffing models should trigger an insurance review. We can look at your plans and adjust cover as the service evolves, not just once a year.

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Can you help if we’ve had serious incidents or historic claims?

Yes. Serious incidents do not automatically exclude you from cover, but insurers will want detail and evidence of learning. We’ll work with you to explain what happened, what’s changed since, and how your governance has improved, so underwriters can make an informed decision rather than reacting to headline information alone.

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Do you only work with large complex providers, or smaller services too?

We work with both. Some providers have just a few complex packages alongside standard home care; others are almost entirely complex and high-dependency. What matters is that we understand your actual risk profile and growth plans, so we can target the right insurers and structure cover sensibly from the start.

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How do we get started with a complex care insurance review?

You can call us, complete our enquiry form, or send your current schedules along with a short summary of your complex caseload. We’ll then arrange a conversation, gather any extra details we need, and go out to the market on your behalf. From there, we’ll come back with clear options and next steps.

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