Intermediate Care a range of integrated services to promote faster recovery from illness, prevent unnecessary acute hospital admission support timely discharge and maximise independent living

Bromley services Intermediate Care beds Orpington Hospital & Elmwood Community Assessment and Rehabilitation Teams (CARTS) Nurses, therapists & healthcare teams who support patients at home Homecare Re-ablement Services Social care services who support people at home the Post Acute Care and Enablement (PACE) service Nurses, therapists & healthcare teams to help patients to get out of hospital earlier and support them at home Admission avoidance Nurses, therapists & healthcare teams who support people at home, to avoid the need for a hospital stay Focus is primarily on the services provided in beds and the service provided by CARTS – but each of these teams works together depending upon what an individual patient needs.

Some terminology…. Step up –offer an alternative to people who need nursing care, but whose condition does not mean they need to be in hospital Step down - Supports people after a hospital stay who still need nursing & therapy care, but do not need to be in hospital any more

Bromley figures

Use of intermediate care beds Both Elmwood and Orpington have been under occupied during 2010/11 Average annual occupancy levels at Elmwood ranged between 86 – 89%. In 2010/11 this dropped to 77% Orpington has only 30 beds open of 40. There has been no significant reduction in patient numbers (either in beds or CARTS) nor reduced outcomes. Probably due to the reducing length of stay The PCT’s ‘Balance of Care’ study identified patients who either did not need to have been admitted to intermediate care beds in Orpington hospital (50%) or need not have been there on the day of survey (97%). Corresponding figures for Elmwood were much lower.

Supporting patients at home: new services In January 2011 we introduced ‘Re-ablement to support hospital discharge’ - short-term placements for those not yet ready for rehabilitation in more cost effective residential & nursing homes or flats in Extra Care Housing. In 2009 the PCT, South London Healthcare Trust and the Council have been jointly providing a PACE (Post Acute Care and Enablement) service to help patients get home sooner, safely and with the right care, with five days intensive support. In December 2010 we introduced an increased Admissions Avoidance service from Bromley Healthcare. These new services all support people outside a hospital environment, reducing the need for intermediate care beds

Comparing Bromley with other intermediate care services Benchmarking data* on Intermediate Care services (2009/10) across 16 comparator London Boroughs shows that, compared to others, Bromley has: A lower percentage of step-up patients managed at home than most other areas (89% compared to an average of 93%). The lowest percentage of step-down patients managed at home (37% compared to an average of 82%) The lowest percentage of total Intermediate Care patients managed at home (55% compared to an average of 86%) Among the lowest percentage of total Intermediate Care patients who were step-up managed (34% compared to an average of 38%). * Excludes PACE number from step down data.

The costs of intermediate care Beds are paid for on a block basis - we are paying for a growing number of empty beds. –Beds at Orpington Hospital are more expensive per bed than those at Elmwood Nursing Home. –An intermediate care bed at Orpington Hospital is nearly four times as costly home-based care.

Key changes The re-commissioned Intermediate Care service will have the same aims and criteria and achieve the same outcomes as the existing Intermediate Care service. The key differences will be: Better care for patients in environments where they prefer to be More flexibility when beds are needed More emphasis on ‘step-up’ care to avoid the need for hospital Better care for people with dementia A better use of NHS & local authority funds