National Evaluation Of Intermediate Care Reports Findings

A study involving researchers from the Universities of Leicester, Birmingham and Sheffield has highlighted significant variation in the development of intermediate care in England.

The study, which included a national survey of intermediate care co-ordinators, data collection in five case-study sites and a systematic review of previous research, focused upon the costs and outcomes of intermediate care for older people.

Research Fellow Emma Regen said: “Findings from the survey of intermediate care co-ordinators reveal that despite national guidance promoting conformity to clearly defined service models, intermediate care has continued to develop in response to local needs and circumstances. As a result provision is characterised by diversity and significant variation between different areas”.

The three-year research programme also discovered that despite the many benefits of intermediate care to service users, it was not always being used to its full potential. Ms Regen added: “Interviews with senior managers and frontline staff in the case-study sites suggest that service users may benefit from the ‘home-like’ setting in which many intermediate care services are delivered, particularly in helping older people lead independent lives. However, our research also indicates that workforce and capacity pressures, combined with a lack of awareness about intermediate care among ‘mainstream’ practitioners, means that intermediate care is currently not being used to its full potential”.

Regarding the costs and outcomes of intermediate care for older people, Billingsley Kaambwa, Research Fellow said: “Analyses of quantitative data collected in the five case-study sites reveal that residential services have a higher cost than non-residential services, and services aimed at preventing avoidable hospital admissions have a lower cost than those which seek to facilitate discharge from hospital”. He added: “Service users’ quality of life was assessed both before and after receiving intermediate care and we found that the largest gains were seen for residential services (as opposed to non-residential) and for admission avoidance schemes (compared to supported discharge)”.

The systematic review of previous research on the costs and outcomes of different models of intermediate care, found that the evidence supporting the development of specific types of intermediate care is mixed with the bulk of evidence relating to supported discharge schemes.

The researchers have identified a set of policy implications for the Department of Health which highlight the need for:

– closer integration between intermediate care and mainstream services

– targeting of those patients in the greatest clinical need

– stronger focus upon admission avoidance intermediate care services (underpinned by further evaluation).