Partners: Healthwatch Westminster, Healthwatch Kensington & Chelsea, The Health Foundation, Imperial College London, NWL ICB
Enabler: Qualitative and quantitative insights
Alignment with the three shifts: Hospital to community
Intermediate care services are short-term support services that aim to help patients to regain their independence after a hospital stay or avoid unnecessary hospital admissions. These services can improve quality of life for patients and reduce pressure on health and care services. However, there is relatively little evidence on their use and effectiveness.
The NWL Networked Data Lab, a collaboration between ICHP, Imperial College London, and NWL ICB, funded by The Health Foundation, aimed to use routinely collected health data to understand who receives intermediate care after a stay in hospital in NWL, and what makes a difference to the number of people who need to go back to hospital.
To achieve this, two research questions were identified considering:
• Access to step-down care (SDC) services across NWL
• Relationship between SDC and hospital readmission rates
We undertook rigorous data analysis – looking at patients with at least one hospital stay, and linking with social and community care data to remove any non-SDC patients. We conducted a sensitivity analysis to ensure that our results were consistent with our definition of SDC.
Alongside this, we worked with our established Patient and Carer Advisory Group, all with lived experience of intermediate care, to understand their experience of accessing SDC. We combined these findings with qualitative insights from our local Healthwatch teams.
The group worked with us throughout the project to determine what questions we asked of the data, to help make sense of our results based on their lived experience, and to develop communications to share our findings with decision makers and community members to achieve real change.
Our combination of quantitative and qualitative analysis found:
• Identifying patients: It’s difficult to identify patients that receive SDC. There is a need to improve routine data collection processes, particularly for social and community care data.
• Location matters: Where a patient lives significantly impacts their likelihood of receiving SDC. Patients in Hillingdon are approximately 10 times more likely to receive SDC compared to those in Hounslow. Patients in the most deprived areas are approximately 5% less likely to access SDC compared to those in highest IMD bracket (measure of deprivation).
• Characteristics: Rate of access to SDC increases with age, with patients over 80 being most likely to access SDC. Frailty, living alone, and being a woman also increases chances of accessing SDC.
As a result:
• Prioritising step-down care: This data can help prioritise SDC being delivered to the patients who need it most. For example, patients who go on to receive SDC are more likely to be seen by certain medical specialties. These patients could be identified earlier during their hospital stay so SDC can be put in place.
• Distributing and informing future work: Our insights have been shared with both local and national stakeholders, to inform future change.
“At every stage we felt valued and our contributions were taken seriously and respected.”- Patient and Carer Advisory Group member
