Intermediate care services have had a notoriously uneven and
diverse development in recent times. So much so, in fact, that the
Department of Health (DoH) has observed that a range of models has
emerged “based on local need, happenstance or opportunism. A
thousand flowers have bloomed”.1
This can be seen as both a strength and a weakness. Undoubtedly
it has been possible for intermediate care to develop in response
to different needs and circumstances, but the resulting
proliferation of different models has also led to some confusion,
fragmentation and poor strategic direction. As the DoH also
acknowledges, alongside the thousand flowers there is “inequality
of provision and access, duplication of effort, reduced
cost-effectiveness and loss of impact”.2
One particular concern has been the poor engagement of the
independent sector in these new service developments. As the House
of Commons health select committee observed last year in its
inquiry into delayed discharges, there has been some apparent
re-badging of services as intermediate care. This has involved
re-opening closed wards under new names, but with little innovative
service provision and little or no attempt to involve the
resources, skills or knowledge of the independent
But the independent sector has plenty to contribute, as can be
seen from the British Red Cross’s Home from Hospital service.
This model uses trained volunteers to provide practical and
emotional support to (mainly older) people after they have been
discharged from hospital. It has proved to be extremely popular
with those who use it, and it has grown substantially in recent
In 1996 we were commissioned by the British Red Cross to
undertake an evaluation of Home from Hospital.4 This
year we were commissioned again to review the service’s
development in the intervening years, and to assist in shaping
strategic direction. Questionnaires were circulated throughout the
British Red Cross, and in-depth interviews took place with a sample
of schemes, and with service managers and commissioners. In 1996
there were 17 Home from Hospital schemes; this year we found 55.
There were particularly strong developments in Wales and south east
The results of the survey are listed in the panel below.
It is important to see the service in context and its
contribution as part of the continuum of support that people need.
A few schemes indicated that they were providing “personal care”,
but most are not, and indeed should not. Rather, they are
delivering the befriending and companionship that is so vital to
many people in regaining their confidence and independence after a
spell in hospital, but which would otherwise be absent from many
In addition to this emotional support, Home from Hospital
volunteers also help with the myriad other practical tasks that
might otherwise fall by the wayside: shopping, bed-making and
preparing meals; looking after pets; helping with paperwork;
accompanying people to appointments; collecting prescriptions and
pensions. As one service co-ordinator remarked: “We respond to any
reasonable request, but this can be almost anything.”
Typically, Home from Hospital is provided under contractual
arrangements with local social services departments, although
primary care trusts are of growing significance in contracting Home
from Hospital, as are joint contracting arrangements between health
and social care agencies.
Interviews with commissioners indicated a high level of
satisfaction, and recognition that Home from Hospital was providing
a highly valued form of support that could not readily be provided
by statutory services. As one commissioner said: “It is practical
stuff that would drain health and social services’ time.
Also, people may refuse statutory services, but be happier to
accept Red Cross. Basically, it gets to people who would fall
through the net.”
Many commissioners recognise that they were receiving
considerably greater value from the service than they were paying
for, and they emphasised the beneficial partnership that had been
established with the British Red Cross. “We couldn’t do it as
effectively as the Red Cross – it is a crucial part of the chain of
care,” said one.
More than half the Home from Hospital schemes had plans for
development, either in terms of size and coverage, or in moving
into other areas of service more closely associated with
intermediate care. Many recognised the scope not only for
supporting people after discharge, but also in providing input to
prevent hospital admissions and to support people in their own
Commissioners also recognise the contribution that Home from
Hospital can make in delivering the new intermediate care agenda.
The need to develop people’s confidence and help them rebuild
social relationships is increasingly seen as a vital aspect of
independence, alongside an emphasis on helping people recover their
physical functioning. Home from Hospital volunteers are
particularly well suited to providing the one-to-one attention
The considerable growth that has taken place in Home from
Hospital in recent years should be cause for celebration. The
expansion of a volunteer-based service such as this is a major
achievement, and is testimony to the enthusiasm and commitment of
staff throughout the organisation, but especially of service
co-ordinators and their volunteers.
However, there is considerable scope for development. In
particular, there are opportunities for Home from Hospital to make
a greater contribution to intermediate care objectives at a local
level. We have recommended that the new model of service might be
called Home from Hospital Plus, offering an integrated package of
support that brings together a range of British Red Cross services
(including equipment loans, transport and therapeutic massage, as
well as Home from Hospital support).
Intermediate care embraces a wide range of services and support.
The potential contribution of the voluntary sector to this sector
is considerable. Trained volunteers should not be seen as a crude
substitute for statutory services, but they can be an invaluable
complement to those services and provide much added value.
The role of volunteers in providing support to people after
discharge from hospital is well established and of proven value.
There are now opportunities to bring the model of Home from
Hospital up-to-date and to position the British Red Cross as a
provider of modern, flexible and responsive services aimed at
maximising the independence of people in the community and filling
a crucial gap that would otherwise exist.
– A copy of the full report Home and Away: Home from
Hospital and the British Red Cross, Progress and Prospects, is
available from the British Red Cross, tel: 020 7235 5454.
- All the schemes support frail older people. Just over half
occasionally support older people with confusion or dementia, and
almost 40 per cent often do so.
- Almost three-quarters of the schemes occasionally provide
support to younger people with physical disabilities, and just over
half occasionally support people with learning difficulties or with
mental health problems.
- Practical help and befriending/companionship are the most
frequently provided types of support (identified by all
- Referral to Home from Hospital is usually made through health
or social services, but more than 90 per cent of schemes also
reported that self-referral was an important pathway to the
service. Word of mouth is significant in people knowing about the
service, and many clients have used Home from Hospital in the
- Home from Hospital offers a time-limited service of typically
four to six weeks’ duration (although there is considerable
flexibility around individual needs).
- Most Home from Hospital volunteers are female (90 per cent).
Typically, they are 55-64 and white, similar to the profile of
those in other spheres. However, some schemes have enjoyed
considerable success in diversifying their volunteer base in terms
of age, gender and ethnicity.
Melanie Henwood is an independent health and social care
analyst. Eileen Waddington is a development consultant with the
Nuffield Institute for Health, University of Leeds.
1 Department of Health,
NSF for Older People – Intermediate Care: Moving Forward,
page 3, 2002
2 Ibid, page 5
3 House of Commons Health
Select Committee, Delayed Discharges, Third Report of
Session 2001-02, HC 617-I, 2002
4 Eileen Waddington and
Melanie Henwood, Going Home: An Evaluation of British Red Cross
Home from Hospital Schemes, Nuffield Institute for Health,
British Red Cross, 1996