Technical / NICE update: intermediate care can improve independence and cut costs

The guideline (NG74) makes recommendations covering the four categories of intermediate care defined in the National Audit of Intermediate Care: crisis response; home-based intermediate care; bed-based intermediate care; and reablement.

Hospital admission and delays in hospital discharge can create significant anxiety, physical and psychological deterioration and increased dependence. Multidisciplinary services, which help people recover, regain independence and return home, are vital. 

In facilitating timely transfer of care from hospital, intermediate care and reablement services aim to maximise independence and reduce hospital admission. Intermediate care uses a range of service models to help people be as independent as possible.

NICE recommends offering reablement as a first option to those being considered for home care, where this could improve independence. This should lead to long-term savings due to lower use of home care and reduced admissions to hospital in the first two years after reablement. Short-term costs are higher, but the net cost of providing reablement for an extra 1,000 people being considered for home care is anticipated to be £293,000. For bed-based intermediate care, the guideline recommends the service is started within two days of receiving an appropriate referral. While the average wait for bed-based intermediate care from referral to assessment is 1.3 days, the average wait from referral to care is three. About 76% of care is provided within two days of referral. So to provide the 24% of care not currently being received within two days of referral will require extra capacity in bed-based intermediate care. This would involve an estimated net cost of £31.3m in England from year five onwards. Increasing capacity in bed-based intermediate care is likely to create capacity in other areas such as consultant-led beds. This may lead to improved productivity for providers and additional income from increased activity.

NICE has produced a resource impact report and template to help organisations assess and plan for the resource impact of implementing the guideline. Intermediate care including reablement services is commissioned by local authorities and clinical commissioning groups (CCGs). There are a number of providers including NHS hospital trusts, local authorities, community providers and not-for-profit social enterprises.

Nicola Bodey is senior business analyst in the Resource Impact Assessment Team at the National Institute for Health and Care Excellence (NICE)