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This short paper summarises a research study undertaken to look at whether an intermediate care episode could be effective in enhancing an individual’s independence, quality of life and in reducing dependency on older people’s care services.

Background
When the NHS Plan was published, it set out a radical ten year programme to modernise the NHS (DoH 2000). An assumption was that intermediate care would be a key component in supporting future policy direction. This was a brave decision to make without conclusive evidence of its effectiveness. With an estimated 2.5 million people using the NHS and Social Services every day, with older people being the greatest user group by far, it becomes imperative that there is robust evaluation to support that decision. The multifaceted nature of intermediate care makes it difficult for a single research methodology to address all aspects of its complexity. Research methodologies should not be seen in isolation from each other when addressing different facets of a research question. Previous studies evaluating intermediate care have been limited to defined topic areas and have not taken a broader view to what affects its outcome.

Scope and aim of this study
This study uses the patient’s journey to support its exploration, by using a mixture of qualitative and quantitative research methodologies. The aim was to explore the complex nature of intermediate care within a defined geographical area (East Riding of Yorkshire). It examines the individual’s journey from prior to admission, following transfer and tries to establish whether the intermediate care episode had been effective in enhancing independence, quality of life and in reducing dependency on care services.

Methods used in the study
We set out to compare perceptions of quality of life and functional ability prior to admission, and on transfer from the service, using validated tools (SF-8 and Barthel). To substantiate if levels of dependency had been reduced, we compared the level of social care received prior to admission, during the intermediate care intervention and with the level of re-provision on transfer from the service. We reviewed individual circumstances at intervals of twenty-eight days and six months, including personal, social, dependency and destination after leaving the service. This included mapping the patient’s journey and exploring individual experiences through a number of semi-structured interviews with both patients and carers. Finally we explored the relationships, expectations and experiences with team members through semi-structured interviews with staff involved in delivering intermediate care and those referring into the service.

What we found
Our analysis drew on a mixture of raw data and individual experiences and perceptions, which allowed us to draw conclusions about a very complex subject.

We found a clear relationship between experience and outcome and that simple things could have the greatest impact on the patient’s experience, and therefore the success of the care service.

One measure which is simple and practicable is to include the patient (and carer) in the decision making process. This greatly enhances the sense of still having “control”.

Also obvious, but sometimes difficult to achieve, are the benefits of a smooth transition from one care setting to another.

For some individuals, who had been independent before their health had forced a change in lifestyle, it was difficult to accept help. Adding to their distress is the sense that they have become a burden on family, friends and neighbours. There was clear evidence that this sense of being a burden was reduced with the support they received.

There was job satisfaction for staff working in the service. The experience of working in a multi-agency/disciplinary team, in particular, was very positive. Individuals referring into the service commented on continuity of care, smooth transition, and quicker discharge planning.

In summary there were a number of clear themes drawn from the analysis. These strengths should be harnessed and transferred to our mainstream services - this will ensure that the patient is kept at the heart of service delivery. This is especially prudent in our current environment.

Main themes:

• Continuity of care
• Smooth transition of care
• Communication two-way
• No barriers between agencies / disciplines
• Single assessment and shared information – reduced duplication
• Patient/carer involvement
• Sharing of resources and expertise

References:
DoH. (2000). The NHS Plan. London. HMSO.
DoH. (2002). Position Statement on Intermediate Care in the North East, Yorkshire and North Lincolnshire London. HMSO.

Wendy Barker RGN, DN, BSc Hons, MSc
Nurse Consultant Older People, East Riding of Yorkshire PCT