Intermediate care can deliver better outcomes for people and reduce the pressures on hospitals and the social care system. Yet its potential has not been fully realised. Evidence offers some clear learning points that can guide the growth of intermediate care.
If I were to try to find a single phrase that would best capture how local areas are going about changing local care and support services, I would say it is ‘promoting independence.’ Read any sustainability and transformation plan (STP), adult social care strategy or local authority transformation plan, and one of the first commitments you will come across is to support more people to live at home, independently with good access to local community resources.
Part of this is about money. We can no longer afford to give the same number of people traditional care packages, but the challenge remains to find ways of supporting people to enjoy more independent lives in ways that are fulfilling. But good support is essential if unnecessary admissions to hospital or residential care are to be avoided, and if people are to be helped to return home safely and recover well.
This is where good intermediate care comes in – services equipped to help people through crises preventing admissions and supporting recovery of which there are four broad models:
1. Bed-based services are provided in an acute hospital, community hospital, residential care home, nursing home, stand-alone intermediate care facility, independent sector facility, local authority facility or other bed-based setting.
2. Community-based services provide assessment and interventions to people in their own home or a care home.
3. Crisis response services are based in the community and provide to people in their own home or a care home with the aim of avoiding hospital admissions.
4. Reablement services are based in the community and provide assessment and interventions to people in their own home or a care home. These services aim to help people recover skills and confidence to live at home and maximise their independence.
We, with the help of Richard Humphries of the Kings Fund and a SCIE associate, have produced a paper summarising the merits and features of good intermediate care, with suggestions on ways forward for commissioners and policy makers.
As the paper argues, well-designed intermediate care can make a hugely positive difference, improve people’s outcomes and levels of satisfaction, reducing admissions to hospital –and long-term social care services – and delayed transfers of care.
Salford is one area where better outcomes are being achieved for people through high quality, integrated, intermediate care. Some 70% of people who were supported through their Stabilise and Make Safe (SAMS) initiative – a short term intervention designed to increase a person’s chance of long-term independence following hospitalisation – achieved full independence. In Somerset, the council saved around £1.6m by working with a local nursing home to provide intermediate care rehabilitation beds.
However, good intermediate care can only emerge where there is both strong partner working across health, local government and housing and a clear vision for good out of hospital care. There also needs to be:
? an integrated approach to planning, funding and delivery of all four models, including shared assessments that are accepted across all services
? capacity planned across the whole patient flow, with a balance found between ‘step up’ services (designed to prevent hospital admissions) and ‘step down’ services (to enable timely hospital discharge)
? strong multi-disciplinary working, underpinned by the right staff and skill mix, with a flexible approach to deployment of staff across the four models of intermediate care
? effective leadership to deliver clarity of shared purpose about intermediate care across the system and drive the development of the service as part of wider transformation plans, not separate stand-alone initiatives
Clear expectations about what intermediate care can achieve, at what cost and over what timescale, should be realistic.
Intermediate care is about keeping people well for longer in their own homes, living fulfilling lives – an important ambition. In their role as system leaders, and commissioners of integrated services, local authorities can be at the forefront of developing models of intermediate care that work locally.
Ewan King is director of business development and delivery at the Social Care Institute for Excellence (SCIE)
SCIE’s Intermediate Care Highlights report can be found at scie.org.uk/prevention/independence/intermediate-care/