Intermediate care services failing to meet demand

Increased pressure to fill intermediate care services with people leaving hospital has limited availability for services aimed at preventing people from going into hospital in the first place.

Findings published today in the second national audit of intermediate care highlight the continued wide variation across the country in the delivery of these important services.

In 2012, the audit calculated intermediate care capacity needed to approximately double in order to meet potential demand. However, there is little evidence from the audit that investment and capacity have increased nationally in 2013 with the exception of two Clinical Commissioning Groups.

Furthermore, with around 70% of service users in bed based intermediate care coming from hospital wards, it appears pressure to support those leaving hospital has resulted in services aimed at preventing hospital admissions to be more limited than highlighted in 2012.

Intermediate care services provide important link

Intermediate care services play an important role in easing the pressure on the health and social care system by helping people to avoid going into hospital unnecessarily; assisting them to be as independent as possible after a stay in hospital; and helping to prevent people from having to move into a residential home until it is really necessary.

They provide a link between hospitals, a person's place of residence and other areas of the health and social care system, from community services and hospitals to GPs and social care. They also help to meet the challenges posed by an ageing population, a rising number of patients with long-term conditions and tighter financial constraints.

The audit findings show that users of intermediate care services had an average age of 82 years and the proportion of people over 85 years had increased from 48% in 2012 to 50% in 2013.

Caroline Abrahams, Charity Director for Age UK said: ‘It is deeply disappointing and also frankly absurd that intermediate services for older people have been even further diminished and so are unable to meet the potential demand.

‘It is extremely short sighted of the NHS not to invest more in services that can reduce the need for avoidable stays in hospital - if someone's discharge is properly supported, for example, they can leave hospital safely and sooner and will be less likely to be re-admitted.

‘Older patients don't just need the right treatment while they are in hospital but the right support when they get home. These services are vital to help older people to return to their previous level of wellbeing and minimise their long term care needs.'

Shortage of mental health provisions

There are also questions raised regarding the combination of staff disciplines included in intermediate care teams, particularly relating to the provision of medical cover. The nursing skill mix is in line with Royal College of Nursing recommendations for basic, safe care but below levels recommended for ideal, good quality care.

However, the findings show mental health workers are rarely included in care teams and access to specialist mental health skills is limited in some parts of the system. This is despite prevalence of dementia of between 20% and 31% in the service user age group.

Professor John Young, National Clinical Director for Integration and the Frail Elderly, Department of Health, said: ‘This is a large national audit of "care closer to home" services that are vital for older people who are recovering from illness. It has shown that the provision of these important community services is still only about half of that needed. This is likely to be causing poor care experiences and delays across the whole health and social care system.'

Claire Holditch, Project Director for the National Audit of Intermediate Care, NHS Benchmarking Network said: ‘The audit provides a tool for commissioners and providers to review their services and assist them in bringing their services up to the level of best performers.

‘Commissioners need to give serious consideration to the overall capacity of their intermediate care services and particularly to what capacity is available to prevent admissions from happening in the first place. Additional investment in services which provide care in the community is vital if pressure on hospitals is to be reduced.'

The audit is a partnership project between the British Geriatrics Society, the Association of Directors of Adult Social Services, AGILE, the College of Occupational Therapists, the Royal College of Physicians (London), the Royal College of Nursing, the NHS Benchmarking Network, the Royal College of Speech & Language Therapists and the Patients Association.