Abstract
Introduction: Intermediate care (IC) is short-term care aimed at maximising patients’ independence. Across the UK, scaling up IC is included in post-pandemic recovery plans. This could reduce pressures on acute services through timely discharge or preventing admissions. The issues IC seeks to address are common across high-income countries.
The Networked Data Lab (NDL) is a network of analytical teams embedded in the UK health and care system. Each year, we support five local partners with acquisition, linkage and analysis of new health and social care datasets. Our 2023-24 project is focused on IC. Here, we describe analysis of available open data and outline our forthcoming analysis of patient-level linked data that will provide valuable insights on IC.
Public engagement: Patients and the public (PP) played an integral role in our topic selection process and research question refinement. We held a series of workshops with 19 PPs and 7 health and care professionals to discuss potential topics and established a panel of individuals with lived experience of IC to assist with the research questions, interpretation, and communication of results.
Our partners also all consult PP in their local area to inform their analyses.
Methods: We searched for openly available datasets to describe IC in the UK. We were only able to find data on IC for England and for some types of IC. Our results are therefore limited to these areas. We used data from NHS England’s Discharge delays (Acute and community), Adult Social Care Finance Returns and Urgent Community Response datasets.
Results: In 2023, 40,000 people a month discharged from acute hospitals received either home-based/reablement (29,000) or bed-based (10,000) step-down IC, four-times as many as those discharged to a care home. An additional 45,000 people were referred to Urgent Community Response.
We estimated that a further 45,000 start step-up IC (mostly home-based/reablement). Therefore, around 130,000 people enter IC services each month.
There are several blockages in the IC pathway. 12% of discharges from hospital are to IC. But in 2023, at least 1 in 4 people who expected to receive home-based IC and nearly half of those intended for bed-based IC had their discharge delayed. People receiving bed-based IC in community hospitals also face delays – 2,600 people a week had a delayed discharge from NHS community hospitals in 2023.
Rising costs are also an issue. The average local authority spend per IC episode in 2022-23 was 27% higher in real-terms than 2019-20.
Next steps: Our partners’ analyses of linked patient-level data on IC will provide information about who is receiving IC, how it has changed over time and outcomes for patients. The analyses will cover step-down care in England, reablement in Wales and bed-based IC in Scotland. We will also analyse national linked data for England on step-down care. Publication of these findings are expected later in 2024.
Conclusion: IC services are unable to meet demand and, must expand if they are to help reduce acute pressures. Better data on intermediate care is needed to adequately plan and evaluate services.