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:-
- Intermediate Care (reablement/rehabilitation)
- (Intermediate Care at Home)
- The Beacon
- Diana Princess of Wales Hospital-based ICF beds
- Recovery & recuperation bed based service
- Step-up bed based service (part of Rapid Response pathway)
- Rapid Response including nurse triage (linked to NEL Single Point of Access)
- HOME Team (hospital based liaison)
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.
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.
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
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.
Develop further the seamless, integrated nature of Intermediate Tier service delivery as part of the wider NEL integration approach.
- Ensure that capacity meets projected demand.
- Ensure performance is optimized in terms of individual outcomes and to minimize delayed transfers of care associated with access to Intermediate care services.
- Develop step-up/hospital avoidance, further shifting to care at/nearer home where hospital specialist care is not appropriate.
- To focus on rehab/reablement outcomes to reduce long term care and potentially increase rehab/reablement capacity based revised models
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.