National Audit of Intermediate Care 2015

Dr. Duncan R Forsyth is a Consultant Geriatrician at Cambridge University Hospitals Foundation Trust. Here he tells us about the report of the fourth National Audit of Intermediate Care (NAIC) which was released 11 November 2015.

The NAIC provides a unique assessment of progress in community services aimed at maximising independence and reducing use of hospitals and care homes. Three hundred and forty services contributed to the audit with over 12,000 responses from the service user audit and Patient Reported Experience Measure (PREM). Four service categories are examined: crisis response, home based intermediate care, bed based intermediate care and reablement services.

The contribution of intermediate care to crisis response and acute admission avoidance in Catalonia

Marco Inzitari is a geriatrician and Director of Healthcare, Research and Teaching at Parc Sanitari Pere Virgili, Barcelona, and Associate Professor of Medicine at Universitat Autònoma de Barcelona. Here he descibes “Subacute Care Units” which have been set up in Catalonia. He tweets @marcoinzi

An “unbelievable pressure on acute hospitals, with winter on its way…the rapidly ageing population and the increasing number of people with complex long-term conditions, frailty or dementia” describes the English healthcare situation, according to David Oliver’s recent post for The Kings Fund.

This scenario perfectly fits the reality of Catalonia, Spain. A predominantly bed-based intermediate care system is well established in Catalonia: aside from the traditional aim of facilitating early discharges from acute wards, new pathways have been implemented to reduce the pressure on acute hospitals and avoid unnecessary hospitalisation for older patients.

The National Audit of Intermediate Care 2014

Prof John Young is the National Clinical Director for Integration and Frail Elderly for NHS England. He is an Honorary Consultant Geriatrician, Bradford Teaching Hospitals and Head of the Academic Unit of Elderly Care and Rehabilitation at the University of Leeds. Here he updates his recent commentary published in Age and Ageing journal.

Some solutions can be hidden in plain sight. Those of us closely connected with intermediate care will certainly see these services as an important part of the solution for our overheated health and social care system. Perhaps it requires a time of austerity and an ageing population for the potential of intermediate care to be drawn into focus. The National Audit of Intermediate Care 2014 provides this focus. It allows us to take stock; to pose and receive answers to two fundamental questions: can intermediate care deliver good outcomes at an affordable cost; and, is it making a difference?

Keeping or increasing function in frail older people after a hospital admission

Hugh Senior is an epidemiologist at the University of Queensland, Australia, and Matthew Parsons is a gerontologist at the University of Auckland, New Zealand. Their paper Promoting independence in frail older people: a randomised controlled trial of a restorative care service in New Zealand has recently been published in Age and Ageing journal.

Many older people will experience a decline in their level of physical function during the period of developing an acute illness that requires hospitalisation and discharge from hospital. A third will be discharged from hospital having not recovered the level of function that they had prior to becoming unwell. The loss of physical function includes losses in key areas required for independent living such as dressing, bathing, getting out of bed or a chair, toileting, eating and walking across a room. As such, this has an impact on the older person’s ability to live independently and safely at home, and increases both the likelihood that the older person will need to reside at a residential care facility and the likelihood of death. A possible intervention to help older people with hospital associated disability is to provide restorative rehabilitation after discharge from hospital, for those who may benefit, with an aim to return to a level of independence where they can return to their own home.

Strategic planning in Intermediate Care is needed to “unstick” the NHS

Prof John Young is a Consultant Geriatrician in Bradford, UK and National Clinical Director for Integration and Frail Elderly at NHS England. Here he reflects on the 2013 National Audit of Intermediate Care. The full audit report can be found here.

I have been closely involved with the National Audit of Intermediate Care since its inception in 2008. The journey has been challenging but highly rewarding. The audit now covers about half the NHS – remarkable when you consider the commitment required by local staff to collect and submit the data.

The audit is important because it describes services that are otherwise relatively hidden from view in our conventional perception of health and social care. Yet intermediate care, or “care closer to home,” has been quietly developing during the last ten years or so. The focus has always been that of older people with co-morbidities/frailty – just the group that is now so much in the forefront of health and social care thinking. And intermediate care services have always been a platform to develop new ways of working – particularly multi-agency working – and so it is highly relevant to our current interest in service integration.

Closing acute hospital beds for older people – the way to save our services?

Prof David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London.  He is President Elect of the British Geriatrics Society.

At the recent King’s Fund Integrated Care Summit, I shared a speaking platform with David Prior – the new Chair of the Care Quality Commission and a man of experience and sincere commitment to improving patient care. In the course of his talk, he stated that “far too many patients are arriving at hospitals as emergencies, with accident and emergency departments out of control and unsustainable in many parts of the country.”  He added that “the healthcare system is on the brink of collapse” and “if we don’t start closing acute beds and investing instead in community care, the system will fall over”. He stated that with “almost half of hospitals providing care which is either poor or not terribly good,  the pressure means that regulators cannot guarantee there will never be another care disaster such as Mid Staffs”.