What works best in intermediate care?

The National Service Framework for Older People made intermediate care services a priority over a decade ago but little work had been done to describe and assess progress until last year’s first ever National Audit of Intermediate Care (NAIC).   The results were published in September 2012 and show that while large numbers of older people are benefitting from intermediate care services  – with the majority returning to their original place of residence after receiving intermediate care – there is considerable variation in how services are provided.

Intermediate care has dual objectives of preventing unnecessary acute hospital admissions and supporting timely discharge for those ready to leave hospital. The overall capacity of intermediate care is small relative to acute hospital provision. Estimates of potential demand for intermediate care services compared to the capacity identified in the audit, suggest overall capacity may be less than half of potential demand. This gap between demand and capacity raises the question of whether the current scale of intermediate care is sufficient to make an impact on hospital utilisation including reducing emergency admissions and time spent in acute care wards.

Intermediate care services can help to maintain health, respond effectively to crises and ensure older people are only in acute hospital beds when they need to be there.  They can also ensure their discharge is properly supported so they can leave hospital safely and sooner, and crucially they can give patients every chance to return to their previous level of functional independence and minimise their long term dependency on care.

The 2012 audit showed a significant imbalance between step up (admission avoidance) and step down (supporting discharge) intermediate care services.  Intermediate care is heavily dominated by step down services.  Systemic pressures to move patients out of hospital may result in step down cases being prioritised to the detriment of admission avoidance capacity.

The 2013 audit will place emphasis on quality and identifying what works best in intermediate care.  It also includes development of a Patient Reported Experience Measure and other outcome measures for intermediate care.  The scope of the audit has been extended to include homecare re-ablement services and the development of detailed case studies of high performing intermediate care services.

If you would like to participate in the second National Audit of Intermediate Care, then please register your interest now. The final deadline for registration is the end of March.

The NAIC is a partnership project involving the British Geriatrics Society, the NHS Benchmarking Network and other professional bodies, NHS organisations and local authorities.  All Clinical Commissioning Groups, NHS and social care commissioners and providers are encouraged to join this year’s project.

Claire Holditch, Project Director NAIC, NHS Benchmarking Network

Dr Duncan Forsyth, Chair, National Audit of Intermediate Care Steering Group, Consultant Geriatrician, Addenbrooke’s Hospital, Cambridge University Hospitals NHS FT

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