The development of intermediate care services in England

Area of Science:

• Health Policy
• Geriatric Care
• Health Services Research

Background:

• Intermediate care was established as a health policy in England to support older individuals.
• The policy aimed to provide specific services to prevent unnecessary hospital admissions and facilitate timely discharge.
• The effectiveness and integration of these services have faced ongoing challenges.

Purpose of the Study:

• To review the origins and evolution of intermediate care as a health policy in England.
• To critically evaluate the evidence from randomized controlled trials (RCTs) on various intermediate care service models.
• To assess the clinical, service, and economic outcomes of different intermediate care approaches.

Main Methods:

• A comprehensive review of the origins of intermediate care policy in England.
• Analysis of evidence from randomized controlled trials (RCTs) evaluating different intermediate care service models.
• Assessment of clinical, service delivery, and economic outcomes associated with these models.

Main Results:

• The hospital-at-home model emerged as the most effective intermediate care service supported by RCT evidence.
• Despite evidence, intermediate care in England has not fully met its initial expectations.
• Difficulties in adapting staff skills and integrating services with mainstream healthcare systems were identified.

Conclusions:

• The hospital-at-home model represents the most robust RCT-supported approach to intermediate care.
• Significant challenges persist in the implementation and integration of intermediate care services in England.
• Recent national guidance aims to refocus intermediate care on frail older people, including those with mental health needs.