Intermediate Care

Intermediate Care for Older People with Mental Health Difficulties - A Department of Health Funded Section 64 Project

The National Service Framework for Older People for England (2001) describes intermediate care as a new tier of provision between primary and secondary care. In this setting older people should have access to a range of intermediate care services at home or in designated care settings. This should promote their independence by providing enhanced services from the NHS and local authorities to prevent unnecessary hospital admission, provide effective rehabilitation services to enable early discharge from hospital and to prevent premature or unnecessary admission to long-term residential care

A major factor for the project was the development of a comprehensive set of standards. These were developed to assess services across the seven sites involved in the project. The overall findings were that despite all the enthusiasm and commitment to intermediate care for older people with mental health needs there remains:

  1. considerable variation in the style of service provision;
  2. little recognition of the Mental Health needs of Older People;
  3. little linkage between Physical Health Intermediate Care Services and Mental Health Intermediate Care Services;
  4. professional inertia to use Intermediate Care Services with a preference to admit (often inappropriately) to an acute hospital bed from both the older person’s own home and from residential care homes;
  5. weak audit mechanisms to demonstrate quality and effectiveness and
  6. a need for commissioners to fully realise the benefits (including the longer term down stream benefits) of Intermediate Care Services for Older People with Mental Health Difficulties.

Older people with mental health difficulties are some of the most vulnerable people in our society and are particularly sensitive to changes in their environment. Prevention of admission and prompt discharge from instituational care should be available in all localities. A key finding and concern was that in many areas this group are denied access to intermediate care if they are under the supervision of a psychiatrist. This discriminatory practice undermines the whole ethos of fair access to care.

A further key finding is for commissioners as they should adopt and apply the philosophy of World Class Commissioning to Intermediate Care. This means taking an evidence-based approach to the strategic and long-term development of services, with a clear focus on delivering improved health outcomes. To achieve this local partners, including Primary Care Trusts, patients, the public, local authorities, clinicians and providers will need to develop open and innovative partnerships to deliver the best possible Intermediate Care Services for Older People with Mental Health Needs for the local community. This may well be looking at overall health and wellbeing in its widest sense, and include challenging the current range of housing, health and social care for older people with mental health needs and, in some places, the medical model.

Intermediate Care for Older People with Mental Health Difficulties - Final Report (1.08MB)