Following the current discussions about social care reform I thought it would be a good time to reflect on the Intermediate/Step down facilities model that has been promoted and partially implemented in the past few years
Intermediate care is not a new idea. Promoting independence and shifting care away from hospitals and residential homes has been a policy objective for over 30 years. Intermediate care was developed as part of the NHS Plan in 2000 and was one of the national standards in the 2001 National Service Framework Service for Older People.
It is an important focus of efforts to integrate health and social care through the Better Care Fund. It is central to the ambitions of most Sustainability Transformation Plans across the country to shift more care closer to home.
The United Kingdom, and especially England, has relatively few acute hospital beds in comparison to many of our European neighbours. A rising number of those admitted to hospital are older and have increasingly complex conditions. Many of these people have frailty or functional impairment, and most need rehabilitation after their acute illness or injury. Some could be supported at home after initial assessment at hospital or in their own homes.
Intermediate care services can deliver support outside of a hospital setting, potentially helping to speed up discharge, avoid some admissions, provide crucial rehabilitation to maximise independence and reduce the need for long-term care and support. But such models are not always funded or available.
Hospital inpatients are increasingly old. Many are living with frailty and most have a degree of functional impairment, either in mobility or other activities of daily living. Many such patients leave hospital less mobile and independent than when they were admitted, making rehabilitation after acute illness and injury a core issue not just for hospitals but also for their partners in step-down’ intermediate care services. These services also have the potential to provide step-up’ (admission prevention) care, for early supported discharge from the hospital front door or wards.
The development of purpose built Intermediate care or step-down facilities adjacent to acute hospitals has been on the cards for a long time but very few have actually been built. These type of services require the integration of NHS and Local authority services and funding. By definition the level of care provided in these facilities requires a level of acute services and community based care to allow patients’ rehabilitation and recovery.
Should this model be implemented in its true form it would undoubtably provide the best “one stop” care that will allow the discharge of patients from acute beds to facilities where integrated care, recovery and rehabilitation can be provided not only for physical conditions but also providing mental health services. Emergency readmissions within 28 days of leaving hospital run at around 15 per cent for people over 65 and overall numbers are rising. Improving support for older people either to prevent hospital admission (or readmission) or to facilitate discharge when they are ready to leave hospital is key to patient flow and ultimately to delivering the four-hour A&E waiting times target
