Commissioning activity
■ primary care trust/social services department lead
■ strategic view of needs/total bed and service requirements
■ range of services/mixture
■ investment priorities
■ application of health authority flexibilities
■ contracting methods
■ comparative evaluation Service delivery responsibilities
■ promoting understanding and knowledge of local intermediate care and equipment services
■ supporting the development of integrated care pathways
■ acting as a single point of access
■ working with and supporting partner agencies (trusts, social service departments, Independent Sector) in delivering integrated services
■ designing protocols/criteria for access to local services
■ identifying needs/gaps/duplication in local provision
■ working with partner agencies to ensure integration of service delivery across primary and secondary care, community health service, social care, housing/repairs/adaptation, independent sector
■ monitoring take-up, trends, quality and appropriateness of referral
■ evaluation and audit
■ contributing to training, education and local workforce planning arrangements
■ working closely to develop strong links with the new arrangements for a single assessment process and local care management.
SWRO, internal documentation
In conclusion, note that two specific challenges face intermediate care co-ordinators:
Organisational change in care communities (for example, developments in strategic health authorities and primary care trusts) may in turn necessitate changes in the way that intermediate care is co-ordinated.
The focus on co-ordination of the current service system must not be allowed to inhibit the identification of further opportunities to develop new service responses or change current working practices and the way resources are currently used.
Adapted from Wilson K & Stevenson J (2001). Intermediate care co-ordination: the function.
London: King’s Fund.
Key points from this section
■ Strong leadership is essential for intermediate care development.
■ Engage the support of existing staff for your plans; the literature on the management of change will be helpful here.
■ Look at the potential for new ways of working by health care teams, rehabilitation teams and rehabilitation assistants.
■ Arrange for medical input into the new services.
■ Look at patient pathways to ensure that the new services are flexible enough to meet the needs of all users and ensure continuity of care.
■ If appropriate, contract out some services to the independent sector.
■ Agree upon a single assessment process with all stakeholders; use tools and scales that meet Department of Health criteria.
■ Look at how the new services will be co-ordinated and what specific tasks will be involved.
Further reading
Audit Commission (2002b). Change here! Managing change to improve local services.
London: Audit Commission. Available at: www.audit-commission.gov.uk/publications/ brchangehere.shtml/ or interactive web-based tool is available free of charge at www.audit-commission.gov.uk/changehere
Burke S & Neilson E (2002). Pharmacists and the new intermediate care agenda.London: Royal Pharmaceutical Society of Great Britain.
Department of Health and Public Services Productivity Panel (2000). Working in partnership: developing a whole systems approach.Leeds: NHS Executive. Available at:
www.doh.gov.uk/ipu/pspp/partner.htm
appointment of general practitioners with special interests: framework.Available at: www.doh.gov.uk/pricare/gp-specialinterests/index.htm
Department of Health/Royal College of General Practitioners (2002). Guidelines for the appointment of general practitioners with special interests in the delivery of clinical services: intermediate and continuing care for older people.Available at: www.doh.gov.uk/pricare/ gp-specialinterests/gpwsioldercare.pdf
Department of Health/Royal College of General Practitioners (2002). Guidelines for the appointment of general practitioners with special interests in the role of service development: primary care coronary heart disease lead.Available at: www.doh.gov.uk/pricare/
gp-specialinterests/gpwsiservdevchd.pdf
Department of Health/Royal College of General Practitioners (2002). Implementing a scheme for general practitioners with special interests.Available at: www.doh.gov.uk/pricare/ gp-specialinterests/gpwsiframework.pdf
Foote C & Stanners C (2002). Integrating services for older people.London: Jessica Kingsley Publishers.
Hall, J (2000). A partnership between British Red Cross and rehabilitation services in South Cheshire. Rehabilitation Development Network News Update5: 10. London: King’s Fund. Howden J (2002). The South Staffordshire Intermediate Care Training and Development Project.
British Journal of Occupational Therapy65(3): 138–40.
Independent Healthcare Association (2002). Engaging the independent sector in the development of intermediate care. London: IHA. Available at: www.iha.org.uk
Institute of Medicine (2001). Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press.
Le Mesurier N (2001). Evaluation of five social rehabilitation projects supported by Age Concern England: aims, working methods and alliances. First interim report. Birmingham: Social Science in Medicine Group, University of Birmingham.
Le Mesurier N (2001). Evaluation of five social rehabilitation projects supported by Age Concern England. Second interim report: Case studies and performance data. Birmingham: Social Science in Medicine Group, University of Birmingham.
McCormack B (2001). Autonomy and the relationship between nurses and older people. Ageing and Society 21(4): 417–45.
McGrath H, George J and Young J (2002). The rehabilitation of older people from ethnic minorities, in Squires A and Hastings M (eds) Rehabilitation of the older person: a handbook for the multidisciplinary team. 3rd edition. Cheltenham: Nelson Thornes.
NHS Modernisation Agency (2002). Improvement leaders’ guide to process, mapping, analysis and redesign, available at: www.modern.nhs.uk/improvementguides/process/
Office for Public Management (2001). The joint appointments guide: a guide to setting up, managing and maintaining joint appointments for health improvement between health organisations and local government. OPM, London.
Ormiston H (2002). The single assessment process. MCC: Building knowledge for integrated care(10) 2: 38–43.
Spencer L (2000). Rehabilitation and rapid response services. Briefing Paper 6. London: King’s Fund Programme Developing Rehabilitation Opportunities for Older People.
Vaughan B, Steiner A & Hanford L (1999). Intermediate care: the shape of the team. London: King’s Fund.