Intermediate care: how much do you need

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Intermediate care how much do you need?

• JOHN YOUNG
• CONSULTANT GERIATRICIAN
• BRADFORD

1. Where have we come fromand
2. Where are we heading..???
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USER EXPERIENCE COMMUNITY CARE

• Piles of unmet need
• Fragmented service provision
• Poor co-ordination of services
• More caring/doing, less enabling/facilitating
• Multiple assessments
• Multiple waiting lists

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The waiting time for an 85y older can be beyond
their life expectancy
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We need a Prince Charming !
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THE NATIONAL BEDS INQUIRY
There will be a variety of forms to intermediate
care. Alan Milburn Febr. 2000
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A COMMON INITIAL RESPONSE TO INTERMEDIATE CARE

• Im going to keep my eyes tightly closed until
  this nasty intermediate care thing has blown over

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(No Transcript)
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AIMS OF INTERMEDIATE CARE

• Responding to, or averting, a crisis
• Active rehabilitation following an acute hospital
  stay
• Where long-term care is being considered
• National Service Framework para 3.12

STRATEGIC AIMS STRATEGIC SERVICE
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Clear service components of I.C.(DoH Health
Service Circular 2001)

• Early discharge or admission avoidance
• Actions based on comprehensive assessment
• Maximises independence
• Time limited
• Multi-agency working

Not pick mix! All components needed
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Clear service components of I.C.(DoH Health
Service Circular 2001)

• Early discharge or admission avoidance
• Actions based on comprehensive assessment
• Maximises independence
• Time limited
• Multi-agency working

(lt2 wks, or max of 6 wks)
Cognitive impairment or low mood state
Words to avoid dementia or depression
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IS I.C. EXPANDING ?

• SURVEY TARGET
• MAR. 2002 2004
• BEDS 2,700 5,000
• PLACES 6,700 1,700
• PTS. 113,000 220,000
• CAPITAL 66m 66m

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Medics start to catch up....
Dear Policy Committee , My girlfriend and I have
been going out for some time and want to try
something different. She has suggested
intermediate care. Will this be painful ? Yours
in hope ,
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The complete geriatrician needs I.C.
Theres something missing in my life
Have you looked under the sofa ?
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2004 Undoubted successes of I.C.
? ? ? ? ? ? ?

• Some funding
• Facilities
• Staff
• Skills
• Joint working
• Service co-ordination
• User satisfaction

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The reflective intermediate care question
Have we made a difference ???
Have we made a sufficient difference ???
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USER EXPERIENCE COMMUNITY CARE

• Piles of unmet need
• Fragmented service provision
• Poor co-ordination of services
• More caring/doing, less enabling/facilitating
• Multiple assessments
• Multiple waiting lists

Is I.C. making a difference?
Marginal or larger?
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Strategic aims of I.C.

• Responding to, or averting, a crisis
• Active rehabilitation following an acute hospital
  stay
• Where long-term care is being considered

Quantifiable impacts
Hospital bed use care home placements
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THE EVOLUTION OF I.C.
EMBRYONIC SERVICE(S)
Multi-agency working
DEFINED I.C. COMPONENTS
Criteria driven IC
How does this work?
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Does anybody want my patient?
R.A.C. Too ill
Care home rehab Not ill enough
Com hosp Were full till Monday
HaH You mean shes got dementia!
L.A. facility Send her along!
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THE EVOLUTION OF I.C.
EMBRYONIC SERVICE(S)
Multi-agency working
DEFINED I.C. COMPONENTS
Criteria driven IC
Single telephone person driven IC
WHOLE SYSTEM I.C.
INTEGRATED WHOLE SYSTEM
Mainstream service
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Intermediate care how much do you need?
Integrated whole system I.C.
Three questions for the day..
1. Conceptual meaning ?
2. Implications for the size of I.C. ?
3. Implications for relationships with other
services ?