The challenges and potential of intermediate care
The challenges and potential of intermediate care
20 March 2024
Key points
- Intermediate care is short-term care aimed at maximising people’s independence. It can reduce pressure on acute services by providing a pathway to timely discharge from hospital or by preventing admission altogether. Intermediate care also aims to improve quality of life for recipients, their families and carers. Some people fund their own care, but more commonly it is funded by the NHS or local authorities, or jointly commissioned.
- Our analysis focuses on England, where more open data were available. We do not know how this picture compares with the rest of the UK due to limited data on intermediate care in Scotland and Wales.
- We estimate around 125,000 people enter intermediate care services each month. In 2023, 39,000 people a month who were discharged from acute hospitals received intermediate care, four times as many as were discharged to long-term care homes. An additional 45,000 people were referred to urgent community response services. A further estimated 41,000 people a month start step-up intermediate care.
- There are several blockages in the intermediate care pathway. In 2023, at least 1 in 4 people expecting to receive home-based intermediate care and nearly half of those intended for bed-based intermediate care were delayed in hospital waiting for care. People receiving bed-based intermediate care in community hospitals also face delays when they are ready to leave – this affected 1,700 people a week in 2023.
- Rising costs have increased the pressure on intermediate care. Average local authority spend on a single episode of care in 2022/23 was 27% higher in real terms than in 2019/20.
- Our analysis suggests a minimum of 4,000 additional intermediate care packages a week are needed to reduce discharge delays related to intermediate care. Intermediate care services need to expand if they are to reduce pressure on acute services.
- Open data on intermediate care are limited and fragmented. Further work on intermediate care is being undertaken by our Networked Data Lab (NDL) using local linked datasets. The NDL is a network of five analytical teams within the UK health and care system working to access, link and analyse new health and social care datasets.
Table 1: Traditional types of intermediate care services in England and Wales
Type of care | Definition |
---|---|
Reablement | Support delivered in someone’s own home or usual place of residence that aims to help them recover skills, confidence and independence. Most commonly delivered by social care practitioners. |
Home based | An intervention delivered in someone’s own home or usual place of residence that aims to support recovery from illness and maximise independence. It can help people move or stay out of hospital. Most commonly delivered by health care professionals, for example, occupational therapists or physiotherapists. |
Bed based | Similar to home-based intermediate care but delivered in a bed-based setting, for example, a community hospital, care home or acute hospital. |
Crisis response | Rapid assessment in someone’s own home in response to a crisis (for example, a fall, infection or exacerbation of an existing condition). If necessary, a short-term intervention is provided (for example, medication or catheter care). In England, crisis response is mostly delivered as an urgent community response service. |
Source: Adapted from NICE guidelines.
A range of organisations are involved in intermediate care. Typically, reablement services are funded by local authorities, while other intermediate care services are funded by the NHS. Some people fund their own care. Services may be provided by the NHS, local authorities, private providers or voluntary sector organisations. Intermediate care is delivered by a variety of health and care professionals, often working in multidisciplinary teams. Key providers include nurses, occupational therapists, physiotherapists and social care workers. Unpaid carers also often play an important role in supporting people receiving intermediate care.
Across the UK, better integration between health and social care services is a long-term strategic aspiration. Policymakers hope improving integration can provide support that better meets people’s needs and allows more care to be delivered closer to home. Intermediate care is central to these plans, given its potential to reduce reliance on hospital services and support people to live independently. Effective intermediate care requires seamless integration as individuals frequently receive simultaneous support from health and social care professionals and transition between health and care services. But the extent of joint working between different areas varies, and the benefits of integration are yet to be fully realised. This means care coordination and data sharing are often difficult between the different organisations and sectors involved.
Increased integration and new models of care have blurred the lines between different types of intermediate care, particularly reablement and home based. Because intermediate care services are designed to meet local needs and use local resources, they vary between locations. Local providers may not identify with the distinct NICE categories in Table 1. Providers may also deliver both long-term and intermediate care, for example, a local authority may commission a home care organisation or care home to provide 6-week packages.
Other services have similar goals to intermediate care. For example, virtual wards and Hospital at Home aim to free up space in hospitals by providing hospital-level care in patients’ homes. Hospital-level care includes blood tests, drug prescriptions and intravenous drips. Intermediate care does not provide hospital-level care but instead focuses on increasing a person’s independence. Continuing health care is NHS-funded care for people leaving hospital, but support is ongoing rather than short term. Although these services are distinct in theory, in reality, the lines are often blurred. For example, in Scotland, Hospital at Home is part of intermediate care, and in some areas of England, virtual wards and intermediate care are delivered by the same team. This analysis focuses solely on the types of intermediate care described in Table 1.
We searched for open data on intermediate care in England, Scotland and Wales. We focused on these countries as they are part of the Networked Data Lab. As we were unable to find suitable open data for Scotland and Wales, our analysis focuses on England.
The key datasets used were:
- Acute discharge data: Discharge Delays (Acute) SitRep, January to December 2023
- Adult social care data: Adult Social Care Activity and Finance Report, 2015/16 to 2022/23
- Community discharge data: Discharge Delays (Community), SitRep, June to December 2023
- Crisis response data: 2-hour Urgent Community Response Performance Metrics, April 2023 to December 2023
We also used statistics from the Intermediate Care Benchmarking Report 2022/23 produced by the NHS Benchmarking Network (not in the public domain).
There are concerns around the quality of the delayed discharge data. For example, the recording of delayed patient numbers and reasons for delays varies between trusts and has changed over time. For more information about the datasets used, our methods and limitations, please see the technical appendix.
A panel of people with experience of intermediate care, either for themselves or people they care for, were engaged at each stage of the design and delivery of the analysis, from topic scoping through to the interpretation of results. Our analysis of available data has been shared at a series of roundtables to understand the wider implications. Participants included national policy, provider, think tank and voluntary, community and social enterprise sector colleagues whose work relates to intermediate care.
In this long read, we first use open data to describe the pathways into intermediate care, estimate how much intermediate care activity happens in a typical month and examine what happens when someone’s intermediate care packages come to an end.
Next, we describe some of the pressures in intermediate care services – delays accessing step-down care, delays in discharge from community hospitals and increasing costs of delivering care. Our focus on these areas was driven by the availability of data, not because they represent the sole pressures in the system.
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