13.11.13
Intermediate services provision ‘half of what’s needed’
There is wide variation in intermediate services, with little evidence that investment and capacity have increased nationally in 2013, the latest National Audit of Intermediate Care shows.
The report, published by the NHS Benchmarking Network, demonstrates the state of services to help people avoid going to hospital. The proportion of people over 85 years using intermediate care services increased from 48% in 2012 to 50% in 2013, making specialist geriatric care more critical.
The audit also raised questions about the mix of staff disciplines included in intermediate care teams, stating that the role of comprehensive geriatric assessment (CGA) should not be under-estimated. This assessment can reduce mortality, institutionalisation and hospital admission, but requires a fully staffed interdisciplinary team.
Other areas which need improvement are waiting times for intermediate services and involving service users in decision making.
Professor John Young, national clinical director for Integration and the Frail Elderly, Department of Health, said: “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.”
Claire Holditch, project director for the National Audit of Intermediate Care, NHS Benchmarking Network said: “The audit provides a tool for commissioners and providers to review their services and assist them in bringing their services up to the level of best performers. Commissioners need to give serious consideration to the overall capacity of their intermediate care services and particularly to what capacity is available to prevent admissions from happening in the first place. Additional investment in services which provide care in the community is vital if pressure on hospitals is to be reduced.”
Dr Kevin Stewart, clinical director of the Clinical Effectiveness and Evaluation Unit (CEEU) at the Royal College of Physicians (RCP), said: “There are increasing numbers of patients who are frail, old, often with dementia, and have long-term conditions.
“These patients require joined up integrated care involving all aspects from GP services, hospitals, through to community and social care. This care is delivered by a wide multidisciplinary team, including specialist care (such as mental health services) if necessary. In order to provide this joined up care for patients it is vital that capacity for intermediate care services grows. We need to ensure these services are available to all patients who need them and to improve upon the patchy provision that characterises these services at the moment.”
The audit is a partnership project 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 - Specialist Section Older People, the Royal College of Physicians (London), the Royal College of Nursing - Older People’s Forum, the NHS Benchmarking Network, the Royal College of Speech & Language Therapist and the Patients Association.
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