Intermediate Care Review Summer 2016

Last year’s Fit for the Future community engagement gave us the opportunity to talk about the challenges of providing quality services which meet the needs of a growing population of older people and the rise in the number of people living with long term conditions in a time of increasing financial constraint.

Our response to these challenges is to set out a programme of change and transformation in which we focus much more strongly on services which help individual patients to remain as well and independent as possible, which are delivered closer to home and which reduce the need for expensive and often unnecessary hospital-based care.

One of the areas we are looking at is services which provide intermediate care for patients within Basildon and Brentwood. These are services for patients who are not acutely unwell, but who still require a degree of care and support. Some of this care is currently provided in the community and in patients’ own homes, and some is provided in a number of intermediate care beds based in community hospitals. An audit of patients using these beds, carried out last autumn, showed that a significant number of patients may have been better off being managed at home with the support of appropriate community-based services.

We are proposing to expand and develop a range of services which provide intermediate care outside of a hospital setting and reduce the number of community care beds from 90 to 59. Healthcare facilities currently occupied by beds for a relatively small number of patients can then be used to provide services for the wider community. With this in mind, the CCG proposes that Mayflower Hospital, currently housing 22 intermediate care beds, would no longer accommodate beds and instead offer a larger range of community/mental health services, and potentially social and primary care services.

In addition, alongside Thurrock Clinical Commissioning Group, we propose to consolidate the dementia beds currently in place at Thurrock Community Hospital (Grays) from the current two wards into one ward. Before this happens we will invest in increasing the capacity of specific teams that support the management of patients with dementia in their homes.

What is intermediate care?

Intermediate care describes short term NHS and/or social care support that aims to help you return to live as independently as possible following a period of ill health, for example following a fall or a period of severe respiratory problems. It is typically in place for a period of three to eight weeks. Intermediate care is not just for elderly people.

Why are we proposing these changes?
  • An audit of patients in Intermediate Care beds carried out in September 2015 found that as many as 40% would have had their needs more appropriately met by a domiciliary based health or social care package.
  • Developments such as the Dementia Crisis Support Team mean that there are many under-utilised beds in the system, particularly within the dementia assessment and challenging behaviour wards. Experience shows that where there is spare bed capacity, those beds are filled, regardless of need.
  • The intermediate care beds are expensive at £105k per bed per year. Services based in the community are more affordable and can offer care and support to a greater number of people whilst also helping to maintain a patient’s independence.
How do we intend to meet the needs of patients requiring intermediate care in the future?

There will still be beds available for patients who need them. However there is evidence that many patients who are currently being cared for in an intermediate care bed may be better off remaining in their own homes under the care of appropriate community based services.

Together with our partner organisations across Essex we are launching new services which provide care and support in a range of different ways, such as the Reablement at Home service, which offers adults across the county up to six weeks of intensive support to regain their independence following a health or social care crisis, and Social Prescribing, where people with specific needs are matched with the appropriate voluntary sector service. We are also planning to invest at least £500,000 in expanding a range of community based services which offer support to patients in their own homes, such as the Dementia Crisis Team, dementia nurses, community therapies and community support workers. In this way we can ensure appropriate intermediate care is offered to a greater number of patients than currently, using our resources more effectively to support the growth in demand.

What is the impact on patients?

As currently happens, patients referred for intermediate care will continue to be assessed and offered the care package that best supports them to regain independence. Our proposed changes mean that more patients will be able to remain in their normal place of living, with an appropriate package of care in place. Beds will continue to be based in Brentwood Community Hospital and Mountnessing Court, and, for patients with more severe dementia needs, Thurrock Community Hospital. Patients will no longer be seen as inpatients in Mayflower Community Hospital. Like Mayflower, Mountnessing Court is well served by car-parking and bus routes.

What other options did we consider?

As part of the development of this proposal, we considered a number of potential options for the new configuration of services, including commissioning all beds from one locality - all in Brentwood or all in Billericay, and in particular whether Mayflower Community Hospital or Mountnessing Court offered the best environment for inpatients. Factors such as patient safety, access, opportunities for alternative use of premises, value for money, and ensuring an equitable solution across the whole of Basildon and Brentwood were taken in to account. Mountnessing Court offers an environment which is much better suited to patients with dementia who need intermediate care and those who don’t have dementia. Doctors, nurses and therapy staff all agree that Mountnessing Court offers the best solution for patients.

Mayflower Hospital, a new health and care centre?

As part of this service redesign, there will be space freed up in Mayflower Community Hospital that can then be used to deliver a wider range of services. This will include both community and mental health services but could also include social care and primary care services. We will work with our providers to implement new solutions but would also like you to tell us which services you would like to see delivered from the Mayflower Community Hospital.

For further information download the Intermediate Care Review Summer 2016 document here

Download the Fit for the Future Event Discussion document here

See our information on Have Your Say on the Intermediate Care Review Summer 2016 here