The fact that more than a third of intermediate care episodes end in a hospital readmission is a symptom of an underfunded healthcare system compromised by critical gaps in data that can support patient care, says CSP health informatics lead Euan McComiskie
I hope it’s no spoiler that the answer to the Health Foundation’s latest report ‘Are intermediate care services stretched too thin?’ is a resounding yes. Short-term care services aimed at improving people’s independence are all too often facing a stark choice between using a bed for prevention or for rehabilitation.
The report reveals that step-up care beds are being ‘lost’ due to the delayed discharges of step-down patients, reducing the ability of some intermediate care facilities to act as preventative services.
Lack of rehab causing readmissions
It also found that 37 per cent of step-down care episodes in England resulted in a hospital admission within six weeks, citing the tension between getting patients out of hospital as quickly as possible and preventing readmission. More than a third of those discharged without the right support are bouncing back into hospital. This is yet another example of how the proper rehabilitation after hospital discharge is better for patients, and relieves pressure on the healthcare system.
This is a serious problem for the government to fix as it seeks to rebuild the NHS’s wobbly foundations.
There are 750,000 episodes of intermediate care a year.
According to this report, more than a quarter of a million episodes of intermediate care are ending in a hospital readmission.
For those of us who have worked in intermediate care services (even if my clinical experience is a number of years old now), the findings are depressingly familiar. We all know well how regularly these services receive patients who are not appropriate for the intermediate care service they’ve been referred to.
It is important to see these issues highlighted by an organisation like the Health Foundation as the government moves from its 10 Year Plan vision for England to the nuts and bolts of how it’s going to work.
Staffing supports better discharge decisions
Intermediate care services are struggling to meet an increasing demand. Better resourcing would allow for improved discharge decision making. Because better discharge decisions depend on services being there – complete with staffing and infrastructure - when needed. This is critical if the government’s shift of care towards the community and intermediate care services is to succeed.
The other glaring gap is data. The report from the Health Foundation's Networked Data Lab drew on available data across multiple sites in England, Scotland Wales as well as a deeper dive in and more detailed analysis using the Community Services Dataset (CSDS) in England.
What they found is as you move away from acute hospital sites, the coverage of systems, appropriate devices and, as a result, data gets poorer.
Data gaps hamper patient care
This has a direct impact on patient care, as Hannah Knight, senior analytical manager at the Health Foundation told me. In her words, ‘improving the intermediate care data landscape is crucial for ensuring that services are targeted, effective and accessible.
Patients often move from NHS into local authority care (and vice versa), but their data do not follow. Not sharing data makes funding, staffing, and decisions remarkably difficult.
Investment in systems and hardware, as well as the necessary data architecture, is needed to define the work and demonstrate the impact of intermediate care services. In doing this, the return on investment in these services will become clear. If you don’t count it, it doesn’t count. The next ten years of NHS reforms can’t add up to a sum total of ‘we don’t know whether anything we did worked’.
Again, those of us who work in these services, and advocate on their behalf, will realise the huge impact intermediate care can have on patients, and on alleviating a little of the burden of unnecessary admissions, poorly facilitated discharges, and on other parts of the health and social care system.
The efficient and appropriate flow of people through health and care services is of huge importance. Data flow is a crucial piece of the puzzle allowing us to anticipate and plan for the healthcare needs of today, and the future.
I hope that this excellent report from the Health Foundation Networked Data Lab is just the start of opening up both the people and the data flows we need.
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