On shaky foundations

The advent of intermediate care, which bridges
the gap between existing health and social care services, is a
positive step. But has the government set up councils to fail by
not ring-fencing cash for it, asks Jon Glasby.

I have heard that the government is investing
in intermediate care, but I don’t see any evidence of this at
ground level. Is there extra money for intermediate care?

“Intermediate care” is a relatively new phrase
to describe services that have been identified as a priority for
some time by practitioners and researchers alike.

In 1997 the Audit Commission stressed the need
for greater rehabilitation opportunities to break out of the
“vicious circle” in which increasing hospital admissions lead to
quicker discharges, greater use of expensive residential care, less
money for prevention/rehabilitation and hence even more hospital
admissions.

This statement was followed in 1999 by the
Royal Commission on Long Term Care, which called for a greater
focus on prevention and rehabilitation. In 2000, the
government’s NHS Plan responded to these calls, announcing an
extra £900 million for intermediate care over the next three
years.

Further details of how intermediate care will
operate have since been provided by a government circular and by
the National Service Framework for Older People.

As the name suggests, intermediate care is a
means of bridging the gaps between existing health and social care
services. In government documentation, intermediate care has been
defined as: “A short period (normally of no longer than six weeks)
of intensive rehabilitation and treatment to enable patients to
return home following hospitalisation, or to prevent admission to
long-term residential care; or intensive care at home to prevent
unnecessary hospital admission.”¹

While much of the detail has still to emerge,
intermediate care services will be time-limited – usually less than
six weeks, provided free to service users and characterised by
joint working with a single assessment process, a single
professional record and shared protocols. Early signs suggest that
intermediate care may focus on acute hospital beds, thereby seeking
to reduce unnecessary admissions and ensure that patients can be
quickly and successfully discharged at the end of their stay.

Unfortunately, the promise of an extra
£900 million to fund intermediate care is more complex than it
may at first appear.

A government circular – HSC 2001/01;
LAC(2001)/1 – explains that some extra money is being provided to
the NHS for intermediate care purposes.

Despite this, social services departments will
generally not be able to draw on new sources of funds and, by and
large, will be expected to contribute to intermediate care from
existing income and government grants.

Guidance suggests that the government has
already taken account of the need to develop intermediate care
services when allocating funding to local authorities from 2001
onwards. The only exception is a new performance fund of £50
million, which will be available from 2002-3 and will focus
initially on the intermediate care field.

It seems as though local authorities will have
to develop intermediate care in addition to their existing
responsibilities without necessarily having adequate funds to do
so. By expecting social services departments to allocate money to
intermediate care from existing sources of revenue, the danger is
that any increase in annual budgets will have been identified and
spent before intermediate care gets a look in. This could lead to
further arguments with the NHS as councils struggle to fulfil their
side of the intermediate care agenda.

Although intermediate care seems an important
step forward, the government is running the risk of setting local
authorities up to fail by neglecting to provide additional,
ring-fenced funds to make the new system work.     

¹ National Service
Framework for Older People: Modern Standards and Service
Models, Department of Health, p156, 2001.