Intermediate care is under pressure with demand outstripping capacity, according to a national audit by a group of leading healthcare organisations.
The findings of the National Audit of Intermediate Care, now in its second year, suggest the scale of intermediate care is too limited to decrease the number of frail elderly patients in acute hospital beds.
In last year’s audit it was concluded that capacity needed to double to meet demand. However, this year’s audit shows there has been little investment in intermediate care, with the exception of two clinical commissioning groups that doubled their funding.
The audit’s emphasis on community care services as a means of reducing pressure on the system as a whole mirrors the focus of the Urgent and Emergency Care Review, released by Sir Bruce Keogh today. This said care should be provided as close to patients’ homes as possible in an attempt to relieve the pressure on accident and emergency departments.
Writing in the audit’s introduction, John Young, the national clinical director for integration and the frail elderly at the Department of Health, said: “’The hospital is full’ has become a dependable barometer for the NHS and is increasingly popularised by our media. ‘The community and social care is full’ is arguably a more truthful statement.”
Professor Young said intermediate care provision seemed to be “stuck”, with no improvement on last year.
He added: “This is a large national audit of ‘care closer to home’ services that are vital for older people who are recovering from illness. It has shown that the provision of these important community services is still only about half of that needed. This is likely to be causing poor care experiences and delays across the whole health and social care system.”
In 2012, the audit focused on health-based bed and home intermediate care services. This year the study has been extended to cover crisis response and social care reablement services.
The findings suggest that intermediate care is not significantly helping to reduce pressure on hospital admissions. Only 3 per cent of home based intermediate care referrals, 1 per cent of reablement referrals and 18 per cent of crisis response referrals came from emergency departments.
Meanwhile, 20 per cent of bed-based services reported an average waiting time from referral to commencement of service of four days or more, with two-thirds of service users waiting in wards in acute hospitals.
The audit also found evidence of “weak local strategic planning processes” and long waiting times for patients to access services - 3.4 days for bed-based services, 4.8 days for home-based services and 4.2 days for enabling services.
Despite this 95.3 per cent of the 8,000 service users surveyed said they were satisfied with their waiting times.
The crisis response teams and home-based services appear to be working well within the wider health and social care systems with referrals received from primary, secondary, community and social care sources, according to the findings.
However, reablement services seem more independent with 43 per cent stating that they are operating separately from intermediate care services.
Less than half of the respondents - 44 per cent - provide performance reports to their local clinical commissioning group.
Elderly service users make up a large proportion of intermediate care with an average age of 82 years. The proportion of people over 85 increased from 48 per cent in 2012 to 50 per cent in 2013.
The audit found that despite the prevalence of dementia in service users, between 20 per cent and 31 per cent, mental health workers are rarely included in intermediate care teams and only half of staff have received dementia care training.
There is increasing demand for intermediate care for patients leaving hospital, with 70 per cent of patients in bed-based intermediate care coming from hospital wards.
The audit is a joint undertaking between the British Geriatrics Society, the Association of Directors of Adult Social Services, AGILE - Chartered Physiotherapists working with older people, the College of Occupational Therapists, the Royal College of Physicians, the Royal College of Nursing, the NHS Benchmarking Network, the Royal College of Speech & Language Therapists and the Patients Association.