Older people missing out on services to support independence

Thousands of older people are missing out on support to regain or maintain independence because of a lack of intermediate care services, a national audit of provision has found.

Levels of intermediate care may need to be more than doubled to meet demand, found the audit by the NHS Benchmarking Network. Intermediate care includes both services to prevent hospital admission (“step-up” provision) and those to help people return home and regain independence after a spell in hospital (“step-down”); it can be provided at home or in bed-based settings such as community hospitals or nursing homes.

The audit found that 793 people per 100,000 aged 65 or older may have entered acute hospitals inappropriately in 2011-12 compared to 670 per 100,000 who were referred to step-up intermediate care services. A similar gap was found in step-down provision, with 991 elderly patients per 100,000 potentially needing intermediate care but only 472 per 100,000 actually being referred.

The report also found that people with dementia were under-represented among service users, with 12% of users recorded as having the condition compared to 20% of older people in the community and 31% in acute hospitals. It also found that care home residents were “infrequent” users of intermediate care.

The report also highlighted the predominance of health over social care staff in intermediate care provision, with the latter making up 24% of the workforce in home-based services and 8.5% of staff in bed-based services. Just 0.6% of staff are mental health workers.

The vast majority of referrals to both bed-based and home-based services came from health services, with “limited access to bed-based provision from social care”. The NHS Benchmarking Network recommended that commissioners review arrangements and patient pathways to ensure that intermediate care is considered before patients are admitted to acute services or long-term care.

However, the audit found a lack of joint planning of intermediate care in some areas, with services jointly commissioned by the NHS and councils in 58% of areas, and around one-third of areas lacking a multi-agency board to oversee intermediate care.

David Oliver, national clinical director for older people at the Department of Health, said intermediate care has an important part to play in helping improve independence among older people and reduce unnecessary time spent in hospital. “This national intermediate care audit makes an invaluable contribution to our understanding,” he said. “It has certainly enhanced my own understanding and I am sure will be of wide use to the whole sector in shining a spotlight on this previously poorly investigated area.”

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