The NHS Benchmarking Network held the National Audit of Intermediate Care (NAIC) National Conference on 15th November, presenting the findings to a full audience in Birmingham. We were pleased to welcome several exhibitors to this event, who were available for delegates to discuss their activity throughout the day, including NHS Elect and NHS England (REACH and Hospital to Home teams).
Our delegates were welcomed by Dr Duncan Forsyth, Chair of the NAIC Steering Group and Consultant Geriatrician at Cambridge University Hospitals NHS Foundation Trust. Presenting the keynote address, ‘From Practice to Policy’, was Kathryn Evans, Head of Planning Delivery from the Hospital to Home Team, NHS England. Kathryn’s presentation aimed to discuss how to strengthen and support the partnership between health and social care to improve patient outcomes. She posed discussion points on correctly attributing delays to the true cause, ensuring ambulance services refer to intermediate care instead of conveying patients to the emergency department, and how to rapidly improve the receipt of care this winter.
We then moved onto the highly anticipated NAIC findings, with particular attention on the progress against the NICE Quality Standards, before hearing the service user perspective from Chief Executive Officer for The Patients Association, Rachel Power. The outputs have been shared with Project Leads and you can locate the toolkit on the members’ area to explore the findings further. Some points raised by Claire, NHSBN Director, included:
NAIC 2018 indicates that service users are waiting for bed based intermediate care on average 2.4 days (referral to commencement of service) – slightly over the 2 day wait recommended by NICE (QS 173).
81% of service users in home based intermediate care return home following treatment. This is 71% in bed based care and 81% in re-ablement services. The proportion of service users being discharged back into acute care has reduced between 2017 and 2018 reporting.
The NAIC 2018 service user audit reports that service user outcomes improve as the number of different staff involved in care and support increases, supporting the available research on the effectiveness of multi-disciplinary teams.
Following a detailed overview of the NAIC findings, we welcomed Shane Breen from the Northern Ireland Public Health Agency and Paul Cavanagh from the Health & Social Care Board to the lectern, speaking about their whole system review of intermediate care services. Following the NAIC 2017 results, evidencing that bed based intermediate care can be accessed faster than home and reablement, and that patients prefer to be at home and consequently become more independent, Northern Ireland set about transforming their system with an initial three-year proposed programme and a commitment to multi-disciplinary working and a re-balancing of investment and activity into home-based rehabilitation. Northern Ireland also paid close attention to carers support throughout their system review.
We were delighted to host two good practice speakers, the first being NHS Doncaster CCG who delivered an inspiring presentation on transforming their intermediate care services. This was actioned due to identifying that a redesign of their services would support the ageing population and financial pressures on a local level. Their long term vision included a single assessment process, more flexible community offer, and a smaller integrated health and social care bed/facility based offer.
Following this, we heard from Cambridgeshire & Peterborough NHS Foundation Trust, key partners of their STP programme, who were actively reviewing intermediate care services. To respond to the rapidly growing elderly population and workforce shortages, the STP identified the need to address the challenges with a proactive care approach, focusing on self-management, re-enablement and intensive management of rising risk and high-risk people. Corroborating with NHS Doncaster CCG and the evidence from the NAIC findings, Cambridgeshire & Peterborough have invested in their home-based support services, in addition to an integrated workforce to support effective discharges. The integrated communities model across the STP allows stakeholders to have an understanding of all component parts, a shared vision and shared risk, which ultimately will improve patient experience and financial pressures.
Our final presentation was delivered by Professor David Oliver, Clinical Vice President, Royal College of Physicians, reviewing the NAIC so far and what can be expected in the future. David concluded by encouraging delegates to utilise the findings from the NAIC, both nationally and locally, to positively impact intermediate care provision. He also focused on the importance of service user feedback, which is collected in the audit, to provide a robust evidence base for reviewing and transforming services to become more integrated.
Thank you to all delegates, speakers and exhibitors for their input in the conference and audit. Project outputs are available on the members’ area. If you have any NAIC queries, please contact the support team on firstname.lastname@example.org. Our NAIC Wales Findings event will be taking place on 11th December 2018, and the NAIC Northern Ireland Findings event will be held on 1st March 2019.