Intermediate care – designing our way into the community on the Isle of Man

Background: Following the establishment of Many Care 5 years ago the Isle of Man Government issued a Manx Care Mandate under which it would work. The implementation of a Home first Strategy and the requirement to reduce the number of unnecessary hospital stays then fuelled the drive to change the patient pathways away from secondary care and in to an Intermediate care service delivery model.

 

Approach: We identified the types of patients who would benefit from an Integrated Intermediate Care Team which offered, Crisis response, facilitated discharge, community and bed based rehabilitation. We adopted a whole system approach to gathering the data via a point prevalence and incident audit.

The data collection demonstrated that 30 % of patients in hospital could be supported at home with Intermediate care services. There were 30 patients per week who could have stayed out of hospital had there been a crisis response service and 18 of those patients would not have needed an ambulance had an intermediate care service been available.

 

We then followed this up with targeted focus groups across Health and Social care, third sector, family and users groups we identified a list of priories which was deemed necessary for any intended Intermediate care system to have going forward.

These included Single point of access, Free rehabilitative care, Accepting risk keeping patients at home with a requirement for advanced clinical knowledge and skills within the team, Redesign pathways for patients into the community rather than hospital, Rapid access to care and equipment

,Timely access including weekends

We identified gaps between the Reablement service and the proposed Integrated Intermediate Care Service and put this together with the identified needs and brought together the pathway in which the model of care could be delivered and the gap analysis then formed the basis of a comprehensive Business case. The delivery of the new service would be across the 4 pillars of Intermediate care and offered via a single access point, which is available 8 am till 8 pm , 7 days per week.

 

Results: at end of year 1

The BAU Budget year on year is £1,249,151 and the transformation budget used in 24/25 was £1,136,971. Therefore the total budget budget used in 24/25 is £2,386,122. This was offset by a cost avoidance of £4,748,796 in year 1.

The change in flow metrics demonstrated that the:

• ALOS down from 44 days to 23 days , offering 21 days reduction.
• Emergency Department attendance is down 4.2%
• Mean number of medical outliers down from 25 to 14
• Readmission rates reduced
• the number of Opel 4 days at the hospital decreased

 

Key Learning :we adopted a wider criteria which included a discharge to assess process using a duty therapist , an optimisation of care package pathway from the social worker team, the non weight bearing pathway with support in the bed based Intermediate care. We also developed a web based referral form which could be used by clinicians when out at patients homes