[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 3 Issue 2, September 2012].
Unnecessary hospital admissions and longer acute hospital stays by the frail and elderly need to be reduced significantly in order to meet the QIPP challenge over the next four years. Intermediate care provides alternative, community-based services to meet the needs of older people more effectively and to permit more efficient patient flows through the health and social care system.
Given the variety of models in use, the challenge is to discover which approaches to intermediate care actually work best in terms of potential productivity gains and cost savings in secondary care. The “National Audit of Intermediate Care” adopts a whole system approach to studying the effectiveness of intermediate care, with a view to developing suitable quality standards and patient outcome measures. It should also be possible to assess local performance against national standards.
The National Audit of Intermediate Care Report covers patients discharged from intermediate care services during 2011/12, with organisational level data relating to the period 2011/12, compared against data for 2010/11. It builds on pilot studies by the British Geriatrics Society / Older People’s Specialists’ Forum and the NHS Benchmarking Network to measure intermediate care service provision and performance against standards set by Department of Health guidance. The report provides national comparative data for bed and home based intermediate care services.
The audit highlights wide variations in the service models being used nationally; these differences between local health economies being displayed by variations in the extent of multi-agency integration, the scale of services provided and how intermediate care is positioned in the spectrum of health and community services.
There is a lack of support and rehabilitation for elderly patients who need help to recover from falls and following hospital care, this report suggests. Such help is normally provided by joint teams of nurses, physiotherapists and social-care staff in England. This audit estimates the services in place are meeting only half the demand. The report warns that these shortages are likely to cause delays in discharge from hospital and avoidable readmissions. The audit suggests that 984 people out of every 100,000 living in some areas receive help from intermediate care services; which is about half the number who might have benefited.
Guidelines recommend intermediate care should be used for a maximum of six weeks, but between 10% and 20% of patients receive care from the services for 90 days or longer. The report also raises concerns about a variations in standards, pointing out just over half of services are commissioned jointly by councils and NHS trusts.
People with dementia are not excluded from intermediate care but may be under-represented amongst service users of intermediate care (only 12% were recorded as having this condition); by comparison, the community prevalence of dementia is 20% and the prevalence in general hospitals is 31% for this age group. There is an under-representation of people with dementia, “which raises questions about where or whether rehabilitation services for people who also have dementia are provided”. (p.51).
Only 55% of bed based intermediate care services and 60% of home based intermediate care services report that all members of staff have received mental health and dementia training.
The National Audit of Intermediate Care was launched in November 2011 by 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 and the NHS Benchmarking Network.
Read more: BBC News: Elderly rehab services ‘lacking’.
Triggle, N. (2012). Elderly rehab services ‘lacking’. London: BBC Health News, September 12th 2012.
NHS Benchmarking (2012). National audit of intermediate care report 2012. London: NHS Benchmarking Network, September 2012.