An Evaluation of Intermediate Care for Older People – Final Report 2005

1. An Evaluation of Intermediate Care for Older People – Final Report 2005 Institute of Health Sciences and Public Health Research, University of Leeds

2. Study considered structure, content outcomes and costs of Intermediate Care What is it? What are its effects and outcomes?

3. Findings What is Intermediate Care? • Diversity in how it was conceived and implemented locally • Reinforced importance of intermediate care as a “set of bridges at key points of transition in the person’s journey from hospital to home (and vice versa) and from illness/injury to recovery”

4. Effects and Outcomes of Intermediate Care • High level performance indicators – suggestion that new service configurations have changed way people move through services and across spectrum of care Outcomes: (65% returned home, 15% hospital, 2% to residential care) Referrals: all aged 75+ and 50% 85+) • Service delivery – observational data indicate development of IC has led to substantive changes in structure of service delivery and culture and behaviour of commissioners and providers

5. User experiences and outcomes Qualitative data from service users suggest a significant difference to people’s lives Most people made substantial progress along the path to recovery Maintenance of independence depended on • Degree of frailty prior to admission • Illness trajectory • Access to formal and informal resources Need for clarity over what constitutes ‘recovery’ and ‘rehabilitation’

6. A comprehensive intermediate care system should consider: • Service type, content and location • Bridging or integration mechanisms to route people approximately • Case finding and equitable access routes • Skills of multi-professional staff

7. Elements of good user-centred Intermediate Care • An enabling ethos built around activities and goals of value to individual user which boosted confidence and motivation of users to take control over their own recovery • Recognition of and partnership with informal support networks • Link into ongoing practical, clinical and social support from services

8. Concerns • Baton tossing rather than baton passing • Lack of mainstream enabling home support services to continue work • Capacity problems and gaps (home care, equipment and adaptations, social activities/contacts) • Routine data poor – no commonly agreed set of data definitions and no minimum data set

9. Costs • £1.05 billion made available for Intermediate Care in England by March 2004 • Problem of tracking where money had gone • Few pooled budgets emerging • Need for meaningful, consistent and comprehensive method of reporting activity and expenditure which reflects the partnership approach to service provision