NHS intermediate care plan fails to deliver

The concept of intermediate care – whereby patients are more appropriately cared for in the community, which frees up hospital beds and saves money – dates back to the 1970s but research, for the first time, quantifies the implications of the early discharge of patients from hospital and the impact that this has on various intermediate care services such as hospital Trusts, social services, primary care, the voluntary sector and informal carers.

The research, by Les Mayhew, Professor of Actuarial Science and Insurance at Cass Business School, and David Lawrence, Brent Primary Care Trust and Honorary Senior Lecturer, London School of Hygiene and Tropical Medicine, was carried out following earlier Government policy established to expand intermediate care to help solve the NHS crisis.

Professor Mayhew comments: “Our research shows that the NHS could save a maximum of £100 million per year through its intermediate care initiative for each one-day reduction in hospital length of stay – but though worthwhile this is a drop in the ocean when you consider that that the annual healthcare budget is £80 billion.” The research’s primary finding is that intermediate care could potentially deliver savings but only if Trusts are willing to make the initial investment and commitment, which they are not doing at the moment.

“The main problem is that hospital Trusts have effectively attempted to push services into the community by reducing bed capacity, but without considering the resource and planning implications for intermediate care. “The NHS policy of encouraging intermediate care expansion was done with the best of intent but it was left up to local primary care Trusts to implement. Brent Primary Care Trust took the initiative and successfully did this,” says Professor Mayhew.

The researchers recommend that although intermediate care has credibility, the following must happen for non-hospital care to be successful:

• Intermediate care must be better for the patient rather than remaining in hospital.

• Commissioning Trusts must allocate and channel funds more generously if better intermediate care in the community is to be achieved.

• Better information systems are required to ensure care is adequately carried out in the community.

• Better protocols and assessment tools are needed to establish the correct care plans for individuals.

If the above actions are consistently applied over time, with good planning and accounting, the result will be savings for the NHS in the longterm.

The paper also identified a lack of practical guidance from the Department of Health on intermediate care, resulting in less efficient decision-making around substituting acute hospital care with intermediate care options.