Intermediate care framework and community rehabilitation model FAQs

The FAQs set out here are designed to help CSP members and other allied health professionals better understand what the intermediate care framework(ICF) and new model for rehabilitation mean for them, and how to take steps to progress with implementation

The intermediate care framework (ICF) and new model for community rehabilitation were published in September 2023.

The publication of these documents is a landmark moment, and efforts are now turning to how to take forward the actions set out within them.

Frequently asked questions about the intermediate care framework

What is intermediate care?  

  • Time limited, short term (around 6 weeks), health and /or social care provided to adults who need support after discharge from acute and virtual wards to support rehab, reablement and recovery. 

  • Can be entirely health, entirely social care, or (ideally) an integrated service of both. They may be commissioned by the NHS and/or Local Authorities and delivered by providers across health, social care, housing, independent and voluntary sectors.  

What is the intermediate care framework?  

  • The intermediate care framework is best practice guidance and recommended actions for improving step down intermediate care, using a new therapy-led community rehab model of care. It is part of the Urgent and Emergency Care recovery plan. 

How has the CSP been involved?  

  • Working with our partners in the Community Rehab Alliance (CRA) the CSP lobbied for two years for a Director of Rehabilitation in NHSE 2020/2021.  

  • Since the appointment of Jenny Keane into this new role in Dec 2021, NHSE has developed the the Intermediate Care programme. 

  • The CSP has been actively involved along with other CRA partners in programme, influencing the design of the framework and the model.  

  • The ICF draws directly from the 2022 CRA report on data.   

  • The ICF and new model for community rehabilitation reflects the 2022 rehabilitation best practice standards, initiated by the CSP, co-produced with Community Rehabilitation Alliance partners.  

What is it trying to achieve?  

  • Improve people’s outcomes and experience of hospital discharge 

  • Reduce hospital readmissions 

  • Reduce avoidable/ premature long term care provision 

  • Improved patient flow and discharge from hospital settings.  

  • Develop a new national standard for discharge, by improving and standardising community rehab data.  

What should intermediate care services provide patients?  

  • The framework says all patients should be on one of these pathways: 

  • Pathway 0 – community-based assessment of need 

  • Pathway 1 – community-based assessment, home based therapy led interventions.  

  • Pathway 2 – assessment of needs, move to short term bedded care (may be followed by pathway 1)  

Where will the workforce come from the do this?  

  • The CSP has lobbied since the publication of the NHS Long Term Plan in 2019 for staffing to deliver all the commitments to improve access to rehab and patient flow from hospital to home.  

  • The Intermediate Care framework acknowledges the need to increase community rehab capacity.  

  • It advises ICBs to carry out demand and capacity planning to identify the additional workforce required – and based on actual needs against new therapy led model of care, rather than historical referrals based on what was existing resource.  

  • It says this should be included in ICB Workforce Strategy and People Plan, with governance supporting this at ICB exec level and in provider organisations.  

  • The model depends on sufficient registered therapy staff at advanced practice and consultant level and more support workers to carry out activity that can be safely and effectively delegated by registered staff. 

  • The IC framework advises partners in integrated care systems should develop a competency framework for Intermediate Care so services can recruit based on available workforce with the right capabilities.  

Will there be training to upskill the workforce?  

  • Implementation of the new therapy led Rehabilitation Model relies on training to more higher level support workers.   

  • It recommends increased use of apprenticeships in line with the NHS Long Term Plan to both grow and develop the workforce.   

  • It also commits to investment in building data and digital skills in the workforce, working with the CSP to develop training resources.  

Who will lead implementation?  

  • An allied health professional at system level to lead implementation.  

Who will be accountable for this?  

  • A senior responsible officer reporting into the integrated care board.  

Must integrated care boards and providers implement this? 

  • No, the framework and the new model of rehab have strong national support but are guidance, and the recommendations aren’t mandatory.  

  • To turn the model into reality will require CSP members and our rehab partners to help this to happen – e.g. securing leadership roles, supporting workforce mapping, and offering to help with the creation of a competency framework.  

What are some of the key dates for implementation?

  • The intermediate care framework and model of rehab care was published on 15 September 2023 

  • It set out recommended actions for commissioners and providers in the short (winter 2023/24) and longer term (by March 2025)  

Is it implemented anywhere already?  

  • Aspects of the framework and the model are already reflected in best practice, in some cases well established over years. The Framework and model is seeking to make this change universal. 

  • NHS England is working with eight pilot sites: 

  • Leeds Health and Care Partnership HomeFirst Programme launched May 2023  

  • Warwickshire Care Collaborative – Discharge Community Recovery Programme, launched April 2023  

  • One Croydon Alliance – new acute, community & social care teams with integrated IT, financial systems & leadership, appointing 2 joint SROs for intermediate care. 

  • Sussex Integrated Care System – testing the better use of digital tools and a digital dashboard of patient level and aggregated management level data.  

  • Humber and North Yorkshire Integrated Care Board – are creating a pilot system version of OPTICA-Community for providers delivering in hospital and post-discharge community care  

  • Four Localities Partnership (part of Greater Manchester) developing strategies for care and discharge within the dementia care environment. 

  • Walsall Healthcare NHS Trust – building on existing intermediate care service are strengthen their ‘home first’ ethos, aiming to avoid over-prescription of care.  

  • East Kent Health and Care Partnership – are scoping existing short-term services to enable a pooled budget to be set up between health and social care, with a provider collaborative and lead commissioning by the council.   

What about other areas of rehabilitation?  

The intermediate care framework if implemented will improve rehab offer for 100s of 1000s of frail and elderly people currently being let down by the system and denied the opportunity to regain their independence after being in hospital.  

It also has the potential to improve provision of rehabilitation more broadly:  

  • Making intermediate care part of the Urgent and Emergency Care Recovery Plan has pushed community rehab to the top of the policy agenda.  

  • It should provide system levels leadership and strategic accountability for rehab.  

  • It should result in realistic assessments of staffing requirements and help grow the rehab workforce and see this featuring in workforce strategies and People Plans, with governance at the highest level for this.  

  • It should provide data infrastructure that will make visible the value of rehab in terms of outcomes and savings, and the scale of rehab needs.  

What can CSP members do?  

If you are involved in any aspect of intermediate care:  

  • Find out how you can contribute to demand and capacity assessment for intermediate care to influence workforce planning in your area 

  • Find out how you can support the development of a competency framework for intermediate care in your area 

  • Contact the CSP's policy team to share information on how implementation is going.  

  • Check back on this FAQ for further updates  

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