Challenges, benefits and weaknesses of intermediate care: results from five UK case study sites

Emma Regen,Jon Glasby,Graham Hewitt,Hilda Parker,Graham Martin,Susan Nancarrow

doi:10.1111/j.1365-2524.2008.00788.x

Abstract

The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semistructured interviews (n = 61) and focus group discussions (n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the 'framework' method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centredness and the promotion of independence. The 'home-like' environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary teamworking and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and 'mainstream' services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities.

Highlights

First articulated as a formal policy in the NHS Plan (Department of Health 2000a) and forming a key component of the National Service Framework for Older People (Department of Health 2001a) the implementation of intermediate care has been a policy imperative for all those involved in the commissioning and provision of care for older people since 2000
25 interviews were conducted with intermediate care service managers and 21 focus groups were held with staff directly involved in the provision of services
Our findings reveal workforce and funding shortages, poor joint working and scepticism/disengagement on the part of the medical profession as the main challenges to the development of intermediate care

Summary

Introduction

First articulated as a formal policy in the NHS Plan (Department of Health 2000a) and forming a key component of the National Service Framework for Older People (Department of Health 2001a) the implementation of intermediate care has been a policy imperative for all those involved in the commissioning and provision of care for older people since 2000. Some spoke in terms of „discriminatory ageism‟, expressing concerns that older people could be inappropriately diverted away from medical services in a bid to alleviate pressures in acute care (British Geriatric Society & Age Concern 2002, Ebrahim 2001, MacMahon 2001). Others highlighted what they regarded as a paucity of evidence to support the widespread development of intermediate care

Objectives

Methods

Results

Conclusion