Building intermediate care

Two
of our regular panellists offer advice and support.

The
Challenge
"The development of intermediate care here in the London Borough of
Ealing has been driven by a partnership between the acute NHS hospital trust and
social services. While this has led to a fundamental shift in the way in which
the organisations interact (with joint budgets and shared management
responsibilities), furthering the agenda around the promotion of independent
living has been slower with colleagues in primary care, particularly with GPs.
This seems to be a common experience, for which we recognise that we share
responsibility. Any advice from the panel would be gratefully received."

Steve
Barnes, service manager (intermediate care), London Borough of Ealing

Panel
responses

Anthony
Douglas
The dice are loaded against primary care developments as all the key NHS
targets relate to the performance of the acute sector on elective surgery
delays; outpatient waits; A & E waiting times and delayed discharges. There
is little incentive for health service managers to divert large-scale resources
away from acute care. Similarly, GPs are discontented with life at the moment.
They need incentives to participate in new primary care strategies.

Pick
a good practice to pilot an innovative scheme, preferably not the one that does
every new initiative as other practices may dismiss it. Choose a practice that
is modest about its successes and work with them. Perhaps base a care manager
from the intermediate care team, linked with a district nurse. Then talk about
it fully at every primary care forum. Other GPs might conclude their lives
would be easier if they did the same.

Work
with three or four GP leaders and gain their support for the promotion of independent
living, perhaps by developing protocols on access to special needs housing and
home care, which enable GPs to feel more confident in their ability to secure a
greater share of the cake for their patients. Seek to revise local plans so
that GPs planning applications to enlarge their surgeries are not unduly
frustrated. Support your local primary care trust in challenging poor practice
among GPs, and seek allies in driving up standards, and securing more funding
for primary care, by developing a superb needs-analysis that is owned locally.
Not easy, but then it never was!

Claire
Smart
While there are now many national examples of intermediate care good
practice, the necessity of continually developing services may not be realised.
There may be a number of reasons behind this, from schemes being perceived only
as a feature of winter pressures, and the scope and nature of the partnerships,
to the sheer volume of change facing all those involved in the sector.

–
Collaborative approach to capacity planning. The whole systems view.

The
key to the sustained development of intermediate care is the collaborative
approach to capacity planning and building. Involving all potential partners at
the early stages of long-term strategy development can ensure that ownership of
change is implicit. Also, it is important that best use is made of available
local information such as referral rates, reasons for admission into hospital
and long-term care, and that a whole systems view is adopted taking into
account future demand and required capacity.

–
Recognising potential partners.

Partners
are often limited to health and social services, overlooking the vital roles
played by the private and voluntary sectors, and others such as housing and
local educational establishments. Increasing the number of partners can serve
to widen the scope and potential for creative, innovative solutions to the
promotion of independence, as well as increasing the momentum of service
development.

Resources

1
National Service Framework for Older People 2001 at www.doh.gov.uk/nsf/olderpeople

2
NHS/SSI Teaching Notes, Creating an Intermediate Care Team: Challenges,
Resources and Implementation, 2000

3
Pooled Budgets: A Practical Guide for Local and Health Authorities, CIPFA, 2001

4
Margaret Sanderson, Intermediate GNVQ Health and Social Care, Thompson Learning

5
Intermediate Care: Guidance for Commissioners and Providers of Health and
Social Care, available from the British Geriatrics Society (http://www.bgs.org.uk/compendium/comd4.html)