Intermediate care – a massive opportunity despite the challenges
Figures released by the NHS show there were close to 6,000 delayed transfers of care in March alone, and, as the number continues to grow, it’s clear a long-term solution to the problem is needed.
Sanctuary Care’s homes provide the ideal platform for an intermediate care offering. Their layout, which includes a collection of large bedrooms, wide corridors and communal areas situated in suites, enables us to use space flexibly, not only with intermediate care, but also residential and nursing care options. Over the years this design has allowed us to work with CCGs and trusts to provide intermediate care without an initial large investment to change the building or facilities.
Generally, our largest outlay is putting vinyl flooring down in the intermediate suite to support residents who are trying to improve or regain their mobility.
Aside from that, we create a rehabilitation room where we can provide physiotherapy, create an area where residents are able to rebuild their confidence making a drink or meal, and also often an area with mobility aids such as stairs to build strength and confidence.
Staffing ratios are slightly higher for intermediate care support. For example, where there are 15 residents in a general nursing suite we would have three staff, a nurse and two care assistants. In intermediate care we have four staff, a nurse, a senior carer and two care assistants.
We provide the extra staff for intermediate care because residents who come to us tend to require more intensive support than in a general nursing suite to rebuild their confidence and life skills.
Hospitals across the country are facing ever growing pressures on budgets and beds and I believe intermediate care suites are, and could increasingly be, a way to address that burden head on.
When you consider potential cost savings, assuming on average a hospital bed costs the NHS £2,100 a week, we are delivering personalised care and support away from the busy hospital wards at a fraction of that price.
The saving then increases further if you take into account the fines associated with bed blocking. Plus there are potential hidden costs associated with increased acuity in delayed admissions to hospital due to lack of bed availability
Sanctuary Care’s offering
Our intermediate care portfolio continues to grow and we are currently working in partnership with four trusts and CCGs across the country, with an annual contract value of £2.9m.
We have recently secured contracts including a 16-bed suite as part of a two-year agreement with the George Eliot Hospital NHS Trust located within the hospital based in Nuneaton, and 12 en-suite rooms at Upton Dene residential care home with the Countess of Chester Hospital NHS Trust.
Other contracts comprise 15 beds at Watlington and District nursing home with Oxford University Hospitals NHS Foundation Trust, and 20 beds across two care homes with the NHS Greenwich CCG.
We’ve found that to be successful at delivering high-quality intermediate care, which meets our objectives as a provider and those of the trust or CCG we work with and, most importantly, our residents, you have to all work together.
Positive relationships are key – dealing with the right people, in the right roles, from day one. Communication has to be open and honest and there has to be clarity about what each of the parties involved wants to achieve as well as being clear about expectations and having the opportunity to discuss and agree those expectations from the beginning. We have a discussion about exactly what each partner can bring to the table and set clear boundaries, for example around when our care home team will be available to do assessments.
Having this joint approach means we not only benefit from things like the provision of rehabilitation equipment which is provided by other partners, but our intermediate care residents are also supported in a much more holistic way which is what we’re all here to do.
This, I believe, is ultimately where our successes lie. Yes, it’s critical to get the costing right, the relationships working seamlessly between professionals and continuing to be flexible on our model. However, all of that aside, if we’re able to continue to have a positive impact on residents’ lives and often, alter their views of what care homes are really like because we deliver care and support with kindness, in conjunction with other agencies, then to me we have achieved what we set out to.
At times it can be challenging to manage intermediate care contracts, but I genuinely see intermediate care as a massive opportunity for the health and care sectors to work in true partnership for the benefit of both organisations and for our increasing elderly population.