• Review says number of intermediate care staff in Lancashire and South Cumbria should more than double over 10 years
  • This would require major investment, but could deliver £88m of savings against projected costs
  • Health and wellbeing board to “hold ICS to account” for implementation

An external review has recommended a region should more than double its number of intermediate care staff, with a potential saving of £88m.

The external review, carried out by consultancy Carnall Farrar, said the rates of delayed discharges and stranded patients in hospital in Lancashire and South Cumbria were among the highest in England, and putting more resources into intermediate care would help address the issue.

Intermediate care is targeted mainly at frail and elderly patients who no longer need to be in hospital, but who need short-term health or social care support to be discharged. It typically involves reablement, crisis response, home-based, and bed-based care.

The review, obtained by HSJ via a freedom of information request, was commissioned by Lancashire County Council but also involved all the region’s NHS organisations. The findings have been welcomed by council and NHS leaders, with plans now being worked on for potential implementation.

The report suggests the number of intermediate care beds should increase from the current 445 to 550 in 10 years’ time, phased in gradually, and for staff delivering home care to increase from 790 to 1,770 over the same period.

This would require the intermediate care budget to climb gradually, from £43m currently, to £77m in 10 years.

It foresees this resulting in significant savings in acute care for this cohort of patients, with current spending of £358m falling to £321m, despite expected increases in the population and cost inflation.

It claims the new model of care could keep overall spending (including acute and intermediate care) on the relevant cohort of patients to £484m in 10 years, compared to a projected £572m under the current model, which would represent a saving of £88m.

Lancashire and South Cumbria is one of 14 integrated care systems, which means it is considered to have advanced arrangements for collaboration and system working. But it has consistently performed worse than the national and regional averages on the four-hour accident and emergency target in recent years, with problems around patient flow considered to be a key factor.

A paper to Lancashire’s health and wellbeing board, which includes the county’s NHS commissioners, at the end of January referred to the review as part of an intermediate care programme, and members agreed to “hold the integrated care system to account for implementing [the programme]”.

It said a “programme initiation document” had been drafted to describe the transformation plan, resource requirements and benefits, and work would begin to develop an ICS-wide financial and risk management strategy.

The ICS said in a statement: “Implementing a new intermediate care model will support people to receive high quality services and reduce the need for hospital admissions. The plan is to support people to avoid admissions to hospital and to support people to get home from hospital more quickly.”