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When thinking about alternatives to prolonged hospital stays for our patients, or preventing inappropriate admission to hospital and long-term residential care, are we aware of what services are out there or what staff skills are available in local intermediate care services to help the increasing population of older people with mental health problems?

The recent National Audit Office report, ‘Improving services and support for people with dementia’ (NAO 2007), highlights something not at all unfamiliar to those working in many of our intermediate care services: the growing numbers of people with dementia in the community, the significant diagnosis gap and the fact that joint working with specialist services could be greatly improved - and this despite it being two years since Czar’s Philp and Appleby (DH 2005) called for more two-way working between specialist services and intermediate care in ‘securing better mental health for older people’.

Asking the Nurse Consultant SIG
So the question asked to the Consultant Nurses SIG – “What local intermediate care services (ICS) are available for older people with mental health needs?” gathered a response highlighting a great variability and again some room for improvement. Around the country we witness a disparity in service provision: from no services at all, other than parallel running generic ICS and separate specialist community mental health teams (CMHT), common in many areas, to a few services often having a community psychiatric nurse (CPN) working within the ICS. The other genera of service configuration, and least common, exist through the provision of a specialist older people’s mental health intermediate care teams.

In no way claiming to have any scientific standing, this SIG’s responses highlight a range of local services that have grown to meet local population needs. Those integrated services that have specialist workers embedded within ICS, who provide both a clinical and educative role function for the ICS meet the integrative framework set out in ‘Everybody’s Business’ (DH/CSIP 2006) and needs to be on the radar for all service commissioners when looking at the future configuration of intermediate care. This has been our local response in Leicestershire and Rutland and in creating the posts we have realised how early assessment and intervention for a patients group who would not meet ‘specialist services’ criteria, but who have significant mental health needs alongside physical rehabilitative need, benefit from the skills and interventions of expert specialist staff.

ICS should not discriminate against people with mental health problems, but how each locality prioritises and delivers this is often unclear. Clinically and strategically we need to be asking the question: What’s out there and how relevant is it for my patients?

Frazer Underwood RGN, MA.
Acting Deputy Director / Consultant Nurse – Services for Older People
University Hospitals of Leicester NHS Trust

References:
Department of Health (2005) Securing better mental health for older people. London: Department of Health

Department of Health / Care Services Improvement Partnership (2006) Everybody’s Business. London: Department of Health

National Audit Office (2007) Improving services and support for people with dementia. London: The Stationary Office.

BGS Newsletter, October 2007
Issue 13 ISSN 1748-6343 13