Emergency Care Planning for People With Complex Health Needs

People with complex health needs are roughly twice as likely to be admitted to hospital as an emergency compared with the general population — and for preventable conditions, that figure rises to five times higher (NHS Digital). Behind every one of those admissions is a person whose care history, communication needs, and treatment preferences may be entirely unknown to the clinicians treating them.

Emergency care planning changes that. It is the process of documenting a person’s health needs, baseline observations, medication, and treatment wishes so that the right care can be delivered quickly when a crisis occurs — even if the person cannot speak for themselves.

Tools like the ReSPECT process and broader advance care planning frameworks give families and professionals a structured way to prepare.

Whether you are a family carer, a support worker, or someone living with complex conditions, this guide explains what an emergency care plan should include, how to create one, and why it matters.

What Are Complex Health Needs — and Why Do They Make Emergencies Harder?

In UK healthcare, “complex health needs” typically refers to people living with multiple long-term conditions, learning disabilities, physical disabilities requiring specialist equipment, neurological conditions, or a combination of mental and physical health needs.

Emergencies are disproportionately risky for this group for several reasons:

• Communication barriers. A person who is non-verbal or uses Makaton cannot easily explain their symptoms, pain levels, or medical history to an unfamiliar paramedic or A&E doctor.
• Specialist medication regimes. Polypharmacy is common. Missing doses or administering contraindicated drugs during an admission can cause serious harm.
• Reliance on specific equipment. Ventilators, PEG feeding systems, suction machines, and specialist seating all require trained handling.
• Different baselines. A resting heart rate, oxygen saturation, or behavioural presentation that is entirely normal for one person may trigger clinical concern if staff have no reference point.

Without a clear, accessible emergency care plan, clinicians are forced to make critical decisions with incomplete information — and outcomes suffer as a result. This increases the risk of diagnostic overshadowing — where symptoms are wrongly attributed to the person’s disability rather than an acute illness — and can lead to inappropriate treatment, distress, and avoidable hospital stays.

Key Components of an Effective Emergency Care Plan

A robust emergency care plan should cover the following areas: personal details and communication preferences, medical summary and medications, baseline observations, treatment preferences and escalation wishes, and emergency contacts.

Personal Details and Communication Preferences

Start with the essentials: the person’s full name, date of birth, NHS number, GP surgery, and next of kin. Crucially, record how the person communicates — whether verbally, through a communication aid, Makaton, or facial expressions — and note any reasonable adjustments required under the Equality Act 2010.

Medical Summary and Current Medications

List all diagnoses, known allergies, and current prescriptions with dosages and administration routes. Include the names and contact details of any specialist consultants involved in the person’s ongoing care.

Baseline Observations – ‘What’s Normal for Me’

This section is vital. Record the person’s typical vital-sign ranges (heart rate, blood pressure, oxygen saturations, temperature) so that clinicians can distinguish between a genuine deterioration and the person’s normal baseline. For people with learning disabilities or autism, describe what distress, pain, or illness looks like for them — this information can be lifesaving.

Treatment Preferences and Escalation Wishes

Emergency care planning sits within the broader framework of advance care planning — the ongoing process of discussing and recording a person’s future care wishes.

This is where the ReSPECT process (Recommended Summary Plan for Emergency Care and Treatment) plays a central role. A ReSPECT form goes far beyond a simple DNACPR decision. It records personalised recommendations for treatment in a future emergency — covering questions such as whether hospital admission, ventilation, or intravenous medication would be appropriate and wanted.

Where a person has capacity, these decisions are made with them. Where they lack capacity, decisions are made in their best interests under the Mental Capacity Act 2005. Some individuals may also have a legally binding Advance Decision to Refuse Treatment (ADRT), which must be clearly referenced in the plan.

If the person has appointed a Lasting Power of Attorney (LPA) for health and welfare, their details should be prominently recorded so the attorney can be contacted immediately during an emergency.

Emergency Contacts and Care Team Information

List named carers, key workers, community nurses, and any out-of-hours arrangements. When an ambulance crew arrives at 2 a.m., knowing exactly whom to call can make all the difference.

How to Create and Maintain an Emergency Care Plan

Emergency care planning does not need to be complicated, but it does need to be deliberate. 

Follow these steps:

1. Start early. Do not wait for a crisis. Begin the conversation with the person (wherever possible), their family, and their multidisciplinary team (MDT).
2. Use recognised frameworks. The ReSPECT process, NHS Personalised Care and Support Planning guidance, and your local Integrated Care Board (ICB) templates all provide tried-and-tested structures.
3. Make the plan accessible. Ensure it is:
   • Kept in the home in a visible, agreed location (many ambulance services look for plans in the kitchen or by the front door).
   • Recorded on the GP system and shared via the Summary Care Record.
   • Carried by the person if they are mobile — a hospital passport (widely used for people with learning disabilities) or a health passport or digital care summary works well.
4. Review regularly. Update the plan at least annually, or after any significant change in health, medication, or living situation.
5. Share with every provider. This includes domiciliary care teams, agency staff, respite services, and hospital liaison teams. A plan that sits in a filing cabinet protects no one.

The Role of Specialist Care Providers in Emergency Preparedness

Specialist complex care providers play a critical role in making emergency care plans work in practice — not just on paper. At Secure Healthcare Solutions, this means:

• Training care staff to recognise early warning signs using validated tools such as NEWS2 (National Early Warning Score) and RESTORE2 (Recognise, Escalate, Support — a soft-signs monitoring tool designed for care home settings).
• Ensuring every service user has an up-to-date, person-centred care plan that is accessible to all staff — including agency workers arriving on shift for the first time.
• Coordinating with NHS community teams, GPs, and Integrated Care Systems to keep care plans aligned and current. For those receiving NHS Continuing Healthcare, the emergency care plan should align with the broader care package to ensure seamless handover during a crisis.
• Providing continuity of care that reduces preventable emergency admissions — because the best emergency plan is one that is rarely needed.

As a CQC-regulated provider with specialist experience supporting people with learning disabilities, physical disabilities, and long-term conditions, we understand that emergency preparedness is not a one-off task. It is embedded in the everyday care we deliver.

Take the Next Step

Emergency care planning is not about expecting the worst. It is about ensuring that when a crisis does happen, the person at the centre receives care that reflects who they are — their preferences, their needs, and their voice — even when they cannot advocate for themselves.

The process should be collaborative, regularly reviewed, and woven into everyday care delivery. It is one of the most meaningful things a family, a care team, or a provider can do.

If you or someone you care for has complex health needs, our team at Secure Healthcare Solutions can help. We work alongside families, NHS teams, and local authorities to deliver specialist care, including Emergency Care, that puts the person at the centre. Get in touch to find out how we can support you.

References

• https://www.resus.org.uk/respect
• https://www.nhs.uk/conditions/end-of-life-care/planning-ahead/
• https://www.gov.uk/government/publications/mental-capacity-act-code-of-practice
• https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities