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Intermediate care can tackle NHS backlogs

Dr Avinash Hari Narayanan
September 8, 2023

The NHS is under chronically increasing pressure due to various factors, primarily revolving around the triad of an ageing population, a rise in chronic illnesses and lack of resources. General practice in the community and general medicine in hospitals are specialities that frequently face the test of service pressures and cater to the vast majority of the population’s health concerns. 

The NHS exists as an intricate web of services catering to a vast diversity of healthcare and social needs of a demographically greying population, in which intermediate care (IC), an often-overlooked service, is a powerful intervention at the interface of community and hospital medicine. IC supports effective patient recovery, reduces hospital readmissions, and lightens the service burden on the NHS.

IC encompasses a range of interventions and services designed to bridge the gap between hospital care, community care and returning to independent living for patients — a transition that can be nothing short of daunting. This form of care is delivered by a multidisciplinary team consisting of doctors, nurses, therapists, and support staff, who collaborate to provide a comprehensive and highly tailored management plan to each patient's needs. 

It predominantly focuses on patients who may not require acute hospital care but still require medical supervision, therapy, and rehabilitation to regain their independence. It is a vital tool to help patients return to the community to focus on regaining confidence, function and purpose while existing as a safeguard to allow for escalation back to hospital care when the need arises. This streamlines the patient journey, leading to cost efficiencies and improved outcomes.

One of the key benefits of IC lies in its potential to reduce hospital readmissions. A common challenge in healthcare systems worldwide, including the NHS, is the revolving door phenomenon, where patients are readmitted shortly after being discharged due to inadequate post-discharge planning and support. These “failed discharges” are a significant negative burden to both patients and healthcare services. IC breaks this cycle, offering dedicated rehabilitation and recuperation, ensuring that patients are well-prepared to manage their health conditions independently once they return home.

This not only minimises patient burden but allows hospitals to focus on acute cases. The NHS is actively working to shift the focus from hospital-centric care to community-based services, with an emphasis on preventive and rehabilitative measures. IC is a prime example of how this strategy is being implemented effectively.

The NHS is actively working to shift the focus from hospital-centric care to community-based services Quote

By delivering care in patients' homes or in community settings, these services foster a sense of familiarity and comfort, enhancing patient well-being and overall outcomes. Furthermore, this approach helps reduce the risk of hospital-acquired infections and offers a more cost-effective solution for patients who do not require the intensive resources of a hospital.

Offering personalised treatment plans and targeted care enhances patient recovery in IC. Along with a multidisciplinary approach, a return to baseline post-hospital can be achieved faster. IC plays a role in addressing not just the physical needs but also the emotional and social aspects of patient lives, acting as a point of integration for mental health and wellbeing services, in the wake of the mental health epidemic facing western nations.

As the UK, along with many other developed nations, experiences a shift toward an aging population, the role of IC will likely expand and become a key element of service provision. Elderly patients frequently encounter difficulties related to mobility, daily activities, and chronic health conditions, possessing intricate health requirements and a need for specialised assistance. IC not only tackles acute health concerns but also places a concerted emphasis on elevating the quality of life for older adults.

Personalised IC care supports an ageing population to preserve autonomy, maximise functional capabilities, slow the progression of chronic diseases and mitigating the frequency of hospital admissions and reliance on acute hospital-based care.

While IC is undoubtedly valuable, it is not exempt from facing its share of challenges. Notably, the issue of funding stands as a formidable hurdle, given the increasing scarcity of resources in upholding high standards of care. IC also needs to integrate seamlessly within the diverse web of NHS services, often catering to overlapping geographical boundaries, multiple hospitals in multiple NHS trusts and diverse community care services.

A single seamless system is not yet in place but is a long-standing vision in a digital NHS. IC often faces the challenge of definition, where a lack of understanding often leads to unsuitable referrals and suboptimal service usage. This can be addressed as awareness of IC grows in both professional and public circles. Greater effort needs to be placed in defining the role of IC in healthcare systems and supporting its existence as an independent entity in healthcare. Despite its benefits, challenges like funding disparities and lack of awareness hinder its potential. Nonetheless, within these challenges lie promising opportunities for advancement and innovation.

Investing in IC will make the NHS more resilient against demographic challenges while enabling logistical synergy in its services. It is most likely that advancements in healthcare technologies, especially in data analytics and artificial intelligence, will support a more unified NHS, and IC will certainly play a key role in this future. This often-overlooked gem is indeed a diamond in the rough and holds great promise for the NHS and its patients, and it’s about time we begin harnessing its potential.

Dr Avinash Hari Narayanan

Dr Avinash Hari Narayanan MBChB is London Medical Laboratory's Clinical Lead.

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