Intermediate Tier

Summary of document:

‘Intermediate tier services’ are services that promote faster recovery from illness, and stop unnecessary hospital admissions or an early admission to long-term residential care. They also support people when they’re discharged from hospital and help to maximise independent living.

In Stockport we currently have more than 20 intermediate tier services. And while each one has significant strengths for the people of Stockport, they operate very separately. This can make it difficult for other staff and people to find their way about the system.

The existing system focuses on services that help people when they’re leaving hospital. This is where most of the resource and capacity is targeted – helping people recover after illness. These services are known as ‘step-down’ services.

Much less is currently spent on helping to prevent unnecessary hospital admissions, otherwise known as ‘step-up’ services. These would help people before their health or social care needs become too bad for them to manage themselves.

In addition to this, the majority of the current budget is spent on delivering care in community facilities rather than providing them in an individual’s own home where they would get the most benefit. We also know that people in Stockport spend longer in intermediate tier beds than they do elsewhere in the country.

This business case describes how care and treatment could be delivered in a person’s normal place of residence (or as close to home as possible). It describes a 24 hour health and social care system that better meets people’s needs, and offers flexible, person-centred care that will help people when they need to move between hospital and primary care settings.

At the same time, improvements will be made to reduce the amount of time people spend in bed based care. This will see the average time reduce from 4 weeks to 2 in line with the national approach.

In order for these changes to happen, there will be a considerable increase in capacity, taking the number of staff working in the intermediate tier from 170 to 250.

A new way of working is proposed in this business case. Six core parts of the system have been identified:

  1. Intermediate Tier Hub – a single access point available 24 hours 7 days a week (24/7) via one telephone number to assess and signpost people to appropriate services.
  2. Crisis Response – a 24/7 team who can respond to patients in the community who need an urgent response (within one hour) or to urgently arrange an alternative care offer in the community to avoid hospital admission. It will be a team which is made up of nurses, physiotherapists, occupational therapists, health and social care support workers, social workers and mental health practitioners. They will also have access to overnight support, pharmacists, and specialist medical input.
  3. Bed reconfiguration and management – a community bed-based service that brings together health and social care professionals, who are able to offer a range of services within the community to ensure all of a person’s health and social care needs are met within a short period of time.
  4. .Active Recovery at Home – a home-based service that brings together health and social care professionals, who are able to offer a range of services within a person’s home to ensure all of their health and social care needs are met within a short period of time. This team will support both ‘step-up’ and ‘step down’ needs.
  5. Transfer to Assess – a process which is intended to ensure a speedy transfer from hospital to home, and to assess a person’s ongoing needs. Once a person’s immediate medical needs have been met, it is important that they can be discharged from hospital in an appropriate and timely manner.
  6. Revised management arrangements – a single management structure will be put in place to oversee the health and social care teams, to ensure the smooth running of the various services.