A collective sigh of relief could be heard throughout the health, independent and voluntary sectors when the Department of Health released guidance on the development of new intermediate care services in January.We were all very keen to hear what the government considered intermediate care to be, so that we could at least start planning how to spend our designated slice of the promised new money.
Up to this point, we knew from the NHS plan that£900m was to be made available by 2003-04 to ensure active rehabilitation. Since the launch of the plan, many local authorities have said that any tender we put to them should include the provision of intermediate care services. But when questioned more closely as to the nature of the intermediate services they require, they become less clear.
Coupled with the lack of clarity about what constitutes intermediate care has been the added pressure of phrases such as 'pooled budgets' and 'improved partnership'. So health authorities are not only having to take into account all the services which they regard as intermediate care, but also those that their colleagues in social services believe have a valid claim on the money as well.
The release of this document promised to provide us with a government-approved definition of intermediate care, and it almost delivered on that promise. In summary, intermediate care must:
nprevent unnecessarily prolonged hospital stays or inappropriate admission to long-term care;
nbe provided on the basis of a comprehensive assessment and individual care plan;
nhave a planned outcome typically enabling people to resume living at home;
nlast no longer than six weeks;
ninvolve cross-professional working.
As an independent provider of housing and care services for older people, Anchor has two concerns.
The document stresses how intermediate care should be about keeping people in their homes.Yet nowhere does it acknowledge the role that housing plays in a co-ordinated approach to tackling health inequalities. Also, there are many valuable services which, by improving the quality of people's housing, more than fulfil the government's criteria.
These services will not receive new investment because of the extraordinary six-week time limit.
Anchor provides home-from-hospital projects which aim to help older people's discharge from hospital. Anchor Staying Put in Hackney provides large and small-scale repairs and adaptations, and gives financial advice on benefits and grants to an extremely vulnerable group.
One client referred to the scheme by social services was suffering from a chronic chest condition which required her to take oxygen for 16 hours a day.Her bathroom was on the first floor, and she was unable to go upstairs or use the bath alone.Having only recently left hospital she was at a high risk of being re-admitted or having to move into residential care.
But an Anchor scheme helped her apply for local authority grants to have a stair lift and shower fitted, and following an energy assessment, doubleglazing, gas central heating and insulation. This was all discussed with her consultant, who agreed it would greatly improve her health and reduce her risk of being re-admitted to hospital.
This demonstrates the importance of good housing to good health, and also the limitations of placing a six-week time limit on intermediate care.
The statistics tell a similar story. The estimated cost to the NHS of treating illness arising from bad housing is£2.4bn a year. Almost one million people aged 65 or over live in dwellings with the worst energy efficiency ratings.
Back in 1998 Anchor and the National Housing Federation held an event to highlight the links between health and housing. Frank Dobson, the then health secretary, said it was common sense that housing had a vital role to play in co-ordinated approaches to tackling health inequalities. But he also admitted that common sense did not always find its way into policy.
There is a credibility gap between the aims of intermediate care, and the new criteria by which it is defined. Unfortunately the government appears to have passed up an opportunity to acknowledge the vital link between good housing and good health and to invest in a long-term, preventive agenda rather than quick-fix solutions.