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Despite government rhetoric that we should be investing in and developing community based services, in particular our community hospitals, recent surveys show a continued decline in rehabilitation services and closure of community hospitals in England.

James Barrett undertook a survey of rehabilitation beds in 2005 (reported in the newsletter in 2006). This survey was repeated in January / February 2007.

In the 2007 survey 61 (37%) replies were received from 164 of the lead geriatricians approached in each acute trust in England this compares with 74 (45%) replies received in the 2006 survey. Unfortunately the responders for 2007 were not necessarily those who responded in 2006.

This is a complex area and our survey has limitations, nonetheless a picture is emerging across England:

• Rehabilitation bed closures which were thought to be temporary in 2006 are now seen to be permanent. Whether this is a result of decreased lengths of stay and an increase in through put, we cannot say.
• Responders also reported a permanent reduction in hospital based therapists. However, we do not know if this reflects an overall reduction in therapists or simply reflects a shift of resources into non-hospital based settings.

Between 2003 and 2007 members reported a substantial reduction in hospital based older people’s services (34.99% decrease in acute DME beds; 58.98% decrease in rehabilitation beds within a DGH setting; 62.59% decrease in community hospital rehabilitation beds; and 71.05% decrease in NHS Continuing care beds) with an apparent small compensatory increase in intermediate care (4.65%) and transitional care (11.02%) beds.

Beds themselves are clearly not the issue, it is whether older people have access to the rehabilitation services that they need and whether there are clearly identified care pathways.

The 2007 survey also included some additional questions relating specifically to Intermediate Care Services. Results reflect the fact that:

• There is still limited engagement of geriatricians in the design and delivery of Intermediate Care, which we believe is a significant missed opportunity. Responders stated that this was not due to any reticence on their part. However, the failure to involve geriatricians in Intermediate Care services may well mean that there is more going on than the responders were aware of.
• Intermediate care does not appear to have the level of flexibility BGS members would like it to have. It appears to be a Monday (excluding BHs)-Friday 9-5 service when it should be 24/7 and 365 days a year.

Below are the responses to the individual questions regarding Intermediate Care:

Are local intermediate care services -
a. Able to accept referrals for early supported discharge from hospital within 3 working days of referral?

Response: 70% YES 30% NO

b. Able to accept referrals for admissions avoidance within 24hrs of referral?

60% YES 30% NO

c. Able to provide night care?
38% YES 56% NO

d. Accept referrals at week-end?
24% YES 68% NO

e. Able to start-up care at week-ends?
24% YES 60% NO

f. Accept referrals on Bank Holidays?
20% YES 64% NO

g. Able to start-up care on Bank Holidays?
16% YES 66% NO

Intermediate Care services are not perceived as providing a rapid flexible response. Are they designed around the provider rather than the recipient?

In the 2007 survey only 2 centres stated that they had a GP with a Special Interest in Older People (GPwSIOP) and in both instances the GP was aligned to their department for clinical governance, CPD, etc. 38 centres did not have a GPwSIOP. If geriatricians are not being engaged in Intermediate Care services and there are few GPwSIOP, then who is providing medical input to Intermediate Care?

The results of these surveys have been shared with Ian Philp and other members of the Older People’s Specialists’ Societies Forum. The results rang true for colleagues from other professional groups and were therefore noted by Ian. Before we can meaningfully use this sort of information to influence policy we need some further data. It has been agreed that colleagues in AGILE (physiotherapists) and the British Association/College of Occupational Therapists would undertake a similar survey of their members to ascertain the view of physiotherapists and occupational therapists on intermediate care and to try to answer the question: If therapists are reducing in numbers in in-patient rehabilitation, are they moving to Intermediate Care or are we losing therapists wholesale?

Duncan Forsyth
Chair England Council