comment: Development of intermediate care is still facing formidable obstacles

Published: 31/10/2002, Volume II2, No. 5829 Page 17

Two years may seem a long time in politics, but they are a blink of an eye in terms of service shifts. Anyone who doubts that has only to look at the progress of intermediate care. When, in July 2000, the NHS plan announced an 'extra'£900m for intermediate care by 2003-04 and an 'extra' 5,000 intermediate beds there was widespread support.

The proposals were built on the findings of a 1999 national beds inquiry, which concluded that about 20 per cent of the time older people spent in hospital would probably be deemed inappropriate if alternative facilities were in place. It suggested that intermediate care services were needed to act as a bridge between hospital and home and between acute and primary health and social services. But the diverse range and nature of the players involved meant that that this innovation was never set for the smoothish passage accorded to single-sector innovations such as NHS Direct and walk-in centres.

Some observed that intermediate care represented such a challenge to traditional power bases that it would require a revolution in health professionals' thinking.

Two years on there are some signs of sectional interests making themselves felt (cover feature, pages 24-26). The British Geriatrics Society has pointed out that two-thirds of schemes have no geriatrician involvement, while older people's 'czar' Professor Ian Philp has warned against doctors undermining developments simply because they are not involved in them. There are difficulties in tracking investment and identifying the 'new' beds. The private sector believes its potential role is being compromised by short-term contracting. In many places, readiness to develop new services may have been derailed by preoccupations over cross-charging. But none of this represents disillusionment with the policy itself, and the continuing consensus bodes well for the future.

Anyone who doubts the government's continuing commitment to keeper older people out of acute beds should note Alan Milburn's announcement in Washington last week that he was on the point of signing an agreement with private US company United Healthcare Group to provide community services for older people in England.