First framework for intermediate care services

NHS England’s new intermediate care framework following hospital discharge is focused on step-down health and social care provided to adults. It builds on the work of discharge frontrunners to improve discharge planning and freeing-up hospital capacity for those who need it most.

The framework is designed to support Integrated Care Boards (ICBs) to work with a full range of health and social care providers in their local area to improve step-down care, whether commissioned by the NHS or local authority, or jointly. This approach reflects the government's support for local partnerships to go further in terms of pooling local authority and NHS budgets through section 75 arrangements and the Better Care Fund (BCF).

While this framework is aimed at ICBs, there are recommendations for integrated care systems to consider in partnership with their intermediate care services and implement where appropriate and within available budgets. 

The framework

The framework is grouped into four priority areas based on learning from eight frontrunner sites which have been piloting new approaches for people to access step-down intermediate care. 

Recommended actions for ICBs and systems ahead of and during winter 2023/24 are covered under each priority area of the framework together with actions between now and 2025. Summary tables are included at pages 31-34.

Four priority areas

  • Improve demand and capacity planning
    Systems should have a joint demand and capacity plan for intermediate care between ICB, local authorities and other partners. Key to operationalising this is ensuring a flow of data from all partners into the care transfer hubs. 
  • Improve workforce utilisation through a new community rehabilitation and reablement model
    The new model (which should be read alongside this framework) aims to increase capacity and access to high quality therapy for people discharged on intermediate care pathways from in-patient settings and virtual wards.
  • Implement effective care transfer hubs
    Embedding governance structures and an integrated multi-disciplinary team across health and social care and voluntary sectors within the hub is key to ensuring all partners are involved in delivery. 
  • Improve data quality and prepare for a national standard
    NHS England is developing a new national standard for rapid discharge into intermediate care. However, data isn't currently standardised and consistent, and is often in multiple formats. Improved data approaches and the recommendations in the framework will support improvement in the quality, completeness and coverage of data collected at regional and national levels.

Better Care Fund and section 75 arrangements

ICBs and local councils will by now have received approval letters to their BCF plans giving formal permission on NHS minimum contributions. These local plans will cover how the BCF funding will be spent on areas improving performance related to discharge, reducing pressure on urgent and emergency care services and social care, supporting intermediate care capacity, and housing adaptations. Ensuring compliance and assurance of BCF plans will require section 75 agreements to be signed and in place by 31 October 2023 – the same date the consultation on section 75 arrangements closes. 

How we can help

The new framework is welcome news as the issue of who does what when it comes to intermediate care packages is a thorny one. We've been supporting several ICBs on this issue. 

We can support you on the following:

  • managing disputes over the provision and funding of care between stakeholders
  • BCF plans
  • getting your section 75 agreements in place and by 31 October

Do get in touch, we’d love to hear from you. 

Our content explained

Every piece of content we create is correct on the date it’s published but please don’t rely on it as legal advice. If you’d like to speak to us about your own legal requirements, please contact one of our expert lawyers.

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