Lack of dementia training in intermediate care services failing older people

Increased pressure to fill intermediate care services with people leaving hospital has left less capacity to help people avoid unnecessary hospitalisation, the second national audit of intermediate care has revealed.
The audit, now in its second year, also highlighted variation across the country in the delivery of intermediate care, which is provided by different areas of the health and social care system including community services, hospitals, GPs and social care to link care between hospital and a person’s own home.

Last year’s audit predicted intermediate care needed to nearly double to reach potential demand. However this year’s audit exposed little evidence to prove this has successfully occurred with only two Clinical Commissioning Groups doubling investment throughout the country in 2013.

Professor John Young, national clinical director for integration and the frail elderly, Department of Health, said: “This is a large national audit of ‘care closer to home’ services that are vital for older people who are recovering from illness. It has shown that the provision of these important community services is still only about half of that needed. This is likely to be causing poor care experiences and delays across the whole health and social care system.”

Intermediate care services aim to help people avoid going into hospital and to help people remain as independent after a hospital admission as well as providing a way to prevent people from needing to move into a residential home until completely necessary.

The audit also highlighted that a lack of mental health workers across intermediate care teams is preventing people with dementia from receiving the specialised help they most need.

It is thought 20 to 30 per cent of the service users’ age group are living with dementia but people are missing out on vital specialist care including mental health skills because most receive intermediate care from just their GP.

The audit showed only half of home based intermediate care services provide dementia training to all their staff, which has been criticised by the Alzheimer’s Society.

George McNamara said: “People with dementia occupy a quarter of all hospital beds, yet we know they are more likely to be readmitted, stay longer and die in hospital than other patients. We can reduce this vicious cycle of hospital admissions by giving people with dementia the right support within their communities and intermediate care plays a key part in this.

“It is therefore disappointing that only half of home-based intermediate care services provide dementia training to all their staff, especially given that one in three people over 65 will develop dementia. This issue of limited dementia training also extends to emergency services and is timely given the Keogh review into urgent and emergency care, released today. The whole system will ultimately fail if staff do not understand the condition and so avoiding the issue of training is simply not an option.”

Over 8,000 service users were asked for feedback during the audit, which found generally good experiences were described by people who had received positive clinical outcomes. However areas for improvement were described which included both waiting times and involving service users in decision making.

Claire Holditch, project director for the National Audit of Intermediate Care, NHS Benchmarking Network said: “The audit provides a tool for commissioners and providers to review their services and assist them in bringing their services up to the level of best performers.

“Commissioners need to give serious consideration to the overall capacity of their intermediate care services and particularly to what capacity is available to prevent admissions from happening in the first place.

“Additional investment in services which provide care in the community is vital if pressure on hospitals is to be reduced.”