Market Position Statement: Intermediate Services

Intermediate Tier services are concerned with reablement - most often as a “half-way home” service on hospital discharge, recovery as a step down from hospital, and urgent community response with hospital avoidance potential by means of swift interventions at home or using a short term step-up bed.

Services are currently arranged as follows:-

Financial Context

The CCG Commissions Intermediate Tier services through the contract with Care Plus Group, our main Community Services provider. The Integrated Intermediate Tier service is joint funded through contributions
from both Health and Adult Social Care, totalling £8m in 13/14. The funding includes contributions via the Re-enablement and Better Care Fund along with core funding.

Underpinning Principles

National Guidance and best practice for Intermediate Care is a relatively modern concept with policy guidance and funding arrangements emerging and developing in the last 10 to 15 years. The implementation of Intermediate Care services nationally is inconsistent and varied as demonstrated by the recently established (voluntary) national audit regime (NAIC) though there is clearly a significant drive to provide the services and outcomes as described by the guidance.

Under the CCGs predecessor, NEL Care Trust Plus, with the unique arrangements on integration and funding between Health and Social Care, Intermediate Tier (including Intermediate care) services have been a  fundamental strategic feature of the design of the local health and care system.

CCG Responsibiities

The CCG is responsible for commissioning high quality, cost effective  services for the population of NEL and will continue to develop intermediate tier services to minimize the dependency on long term care and hospital services through a variety of intermediate service mechanisms

Current supply

The Care Plus Group is the lead provider commissioned to deliver Intermediate Care Service in NEL.  The lead provider has entered into an integrated partnership arrangement with Northern Lincolnshire and Goole Foundation Trust (NLaG) for the delivery of therapy services that includes Allied Health Professional (AHP) services for Intermediate Care. There are currently a variety of arrangements for the supply of Intermediate Tier bed facilities with Care Plus Group's own facilities, their own contracted supply from community nursing homes and the CCGs direct arrangements with community facilities and NLaG. Care Plus Group also works with focus independent adult social work on integrated call handling arrangements through the NEL Single Point of Access.

Future demands and needs

Demand for Intermediate tier services is predicted to increase both through demographic factors and in that step-up, rapid response and hospital avoidance services have a clear role in the transformation of care services and any shift from hospital to community based care. Further the opportunity to expand the scope and improve outcomes for re-enablement and rehabilitation should be constantly examined.

Strategic direction

Develop further the seamless, integrated nature of Intermediate Tier service delivery as part of the wider NEL integration approach.

Commissioning principles and aims, including timings for any significant developments in commissioning

The commissioning principles with respect to Intermediate care are to ensure that services are delivered in the most appropriate setting, are outcome focused, are high quality, cost effective and patient centered.
In line with the strategic direction and in conjunction with the developing provider network 2014 will need to include the establishment of enhanced hospital avoidance step/up services.

Provider implications – how the CCG expects the market to respond

In the context of the NEL approach to integration, the Healthy Lives, Healthy Futures program and the 7 day working pilot, providers are expected to work together and with the CCG to contribute to the development on improved,  integrated, value for money Intermediate Tier services.

Quality and performance monitoring

Contract KPI and provider performance data reporting covers a significant dataset on activity and outcomes across the range of services.