The case for Intermediate Care
There are at least three reasons why the development of intermediate care requires fresh impetus.
More of the same is not sustainable
The health and social care system faces major challenges arising from squeezed budgets, rising demand, increasing costs, greater transparency about the quality of care, and rising public expectations. Levels of hospital activity – especially admissions – have continued to rise over the last eight years.
These pressures will be intensified by demography. The number of people aged 85 and over will increase by a third over the next ten years, and the number of people living with dementia is expected to grow to around 1.3 million in 2025.
One estimate suggests that if admission rates continue to increase, the growing and ageing population alone means that the NHS would need approximately 17,000 additional beds by 2022 (Smith and others, 2014).
Responding to these challenges with ‘more of the same’ – acute hospital beds and care home places – is not sustainable – or the best option for individuals.
Intermediate care offers a more costeffective, if not cheaper, response.
Performance is variable
There are wide variations in the performance of local heath and care systems in offering care closer to home. Intermediate care could make a much bigger difference to people’s experience, outcomes and use of resources.
Key variations between different parts of the country include (01):
- Emergency hospital admissions of people aged 75 and over varies nine-fold
- Hospital admission of people aged 75 and over from residential care/ nursing homes varies 604-fold
- Admissions to residential care and nursing home of people funded by councils varies six-fold
- The number of people still at home 91 days after being discharged from hospital to a reablement/rehabilitation service varies nine-fold.
Demand for intermediate care is increasing
Investment in intermediate care is not keeping pace with rising need.
Expenditure in recent years has remained static and capacity is around a half of what is required. Reablement capacity is actually falling – despite increasing evidence of its effectiveness – and waiting times for intermediate care are rising (National Audit of Intermediate Care 2015).
As a result, the potential of intermediate care to reduce the pressure on hospitals and social care is under-utilised.
Evidence of effectiveness
Evidence shows that well-designed intermediate care can (02):
- improve people’s outcomes and levels of satisfaction
- reduce admissions to hospital and long term social care services
- reduce delayed discharges.
92% of people who used home-based or reablement services maintained or improved their dependency score (a measure of the help they need with activities of daily living).
93% of people who used bed based services maintained or improved their dependency score.
70% of people who received intermediate care following a hospital stay, were able to return to their own home.
72% of people did not move to a more dependent care setting.
88% of people using health based intermediate care services meet their goals (wholly or partially).
90% of people said they were treated with dignity and respect. There is room for improvement about communicating with and involving people who use services and managing expectation about the short-term nature of the service.
Support from SCIE
SCIE carries out reviews and evaluations of local areas’ strategies and plans for service transformation, including intermediate care, drawing on the latest evidence of what works.
Our support includes:
- reviewing proposals for system and service transformation in relation to national best practice
- analysing and segmenting data to identify the current state of service performance and demand for services
- conducting cost-benefit analysis to establish the potential cost savings and cost avoidance to the whole system
- working collaboratively with local stakeholders and people who use services and carers to re-design services
- producing actionable recommendations.
- SCIE also provides CPD-accredited training.