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Rapid Responses: Rapid Responses published:
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Intermediate Care is Ageist
- Gerard Bulger (9 June 2002)
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Intermediate Care - nobetter than the system already there
- Stephen B FitzGerald (18 June 2002)
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Intermediate Care
- Kalman M Kafetz, Whipps Cross Hospital London E11 1NR (21 June 2002)
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Evaluation of intermediate care underway
- Gillian M Parker, Gerald Wistow and John Young (25 June 2002)
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Gerard Bulger, GP Archway Surgery HP3 0HJ
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Dear Sir, Intermediate care is logical if you do not want people to go to hospital. Since there is no other avenue to obtain rapid assessment of patients and access to diagnostic facilities, hospital remains the safest option, providing the hospital is proactive with a rapid discharge policy. The problems G.P.s have in getting patients admitted, even as arranged admissions, will not be ameliorated by the relatively small sums each PCT spends on Intermediate Care. When discussing which patients are suitable for such services the inherent ageism within the NHS is apparent. A 75 years old patient who is unsteady and has a chest infection is usually regarded as an ideal patient to manage in their own home environment. A 35 year old with pneumonia is regarded as an obvious hospital case. However it is the older patient who is likely to have multiple pathologies, who is to be directed away from the “hi-tech” hospital environment. It is actually quite difficult to even make the diagnosis of pneumonia in the elderly, which will simply present as a fall, (a fall in a younger person is called a collapse). The fever if any will be slight, and signs are not obvious. Only after admission and full assessment and a CXR at the very least will the diagnosis become clearer, and other pathology from mild Parkinson’s through to hyponatraemia from the G.P.’s medication. Intermediate care can only work if we have rapid access to full enthusiastic consultant led assessment 24 hours a day. This requires the full resources of the hospital team. Intermediate Care cannot relieve hospital resources. If it attempts to do so the NHS acknowledges its wish to introduce a two tier service, with lo- tech services for the elderly. Yours faithfully Dr Gerard Bulger MBBS MRCGP
No interests to declare. |
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Stephen B FitzGerald, gp principle the red house surgery,124,watling st,radlett,herts,WD77JQ
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the concept of intermediate care has become almost an article of faith in recent times.in practice what it means quite often to our patients is an unseemly rush to pass the parcel on to someone else, with constant conflict between the various interfaces and nobody prepared to take full responsibility for solving that patients problems.the traditional concept of care being interfaced at only one point ,primary or secondary with each section recognising its own clear area of responsibility ie primary means continuous and secondary means episodes of care could work perfectly well if resourced appropriately.there are not enough resources for either system. of much greater relevance to me as a gp is the concept of the patient with an intermediate urgency of need .these patients are neither so acutely ill that they need immediate hospital admission nor are they able to go onto the usual never never waiting list.as gps we are forced to slot these patients into the system inappropriately as we have no choice between on the day admission and a 3month urgent outpatient appointment. |
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Kalman M Kafetz, Consultant Physician Department of Medicine for Elderly People, Whipps Cross Hospital London E11 1NR
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The problem with government policy on intermediate care is that money is handed out for projects without the local partners demonstrating its need by an analysis of local systems. Thus the government can show it is acting without showing why these actions can have an effect on the local community. Where most medical admissions of elderly people come under a specific geriatric department, much intermediate care is unnecessary. The work of intermediate care, preserving function and preventing institutionalisation, is done from the day of admission to an acute hospital. Where multidisciplinary geriatric services have a low profile, more intermediate care services may be necessary. National targets are inappropriate. These targets will already have been achieved where comprehensive geriatric services, acute, rehabiliation and community have been active. Intermediate care may partially plug the gap where these have not been effective. |
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Gillian M Parker, Director Nuffield Community Care Studies Unit, University of Leicester, LE1 6TP, Gerald Wistow and John Young
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Dear Sir, The editorial on Intermediate Care (BMJ 2002;324:1347-1348,8 June) suggests that there is a need to further understand what intermediate care can contribute to health care and therefore a requirement for evaluation. This is so, and the reason why the Policy Research Programme at the Department of Health called for bids in February 2001 and, together with the Medical Research Council, commissioned a national programme of intermediate care evaluation in September 2001, for completion in the summer of 2004. The following three projects were funded: – A national evaluation of the costs and outcomes of Intermediate Care Services for older people, led by Prof Gillian Parker, Nuffield Community Care Studies Unit, University of Leicester in collaboration with the Health Services Management Centre, University of Birmingham – A Comparative Case Study of Intermediate Care Service Systems and a National Audit of Intermediate Care Expenditure, led by Prof Gerald Wistow, Nuffield Institute for Health, University of Leeds – Post-Acute Care Trial of Community Hospitals, led by Prof John Young, Bradford Hospitals NHS Trust Further information on the nature and scope of these evaluations and contact details for the research teams are available from the programme website at http://www.prw.le.ac.uk/intcare Yours faithfully, Prof Gillian Parker, Director
Prof Gerald Wistow, Director
Prof John Young, Consultant Physician
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