Recurring concern

Unreliable intermediate care arrangements

First to latest report 23 Feb 2016 — 10 Nov 2022

Reports that mention this concern: 2
Times this concern has been raised: 2
Stated actions linked to this concern: 9

What this concern includes

Includes failures of an explicitly identified intermediate care arrangement or service affecting its safe provision or management, including unclear care standards, governance and management responsibilities, inadequate planning, bed or capacity availability, and related controls needed to provide appropriate intermediate care.

What is not included

Excludes generic hospital, care-home or social-care capacity deficiencies unless they are explicitly tied to an intermediate care arrangement.
Excludes generic governance, planning or accountability failures that do not concern the safe provision or management of intermediate care.
Excludes failures limited to downstream discharge, ambulance or admission processes where intermediate care is not itself the deficient system.
Excludes clinical treatment, staffing or environmental deficiencies that are not specifically part of the intermediate care arrangement.

Trends

Reports over time

Reports mentioning this concern, over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

Department of Health and Social Care1

Tameside and Glossop Integrated Care NHS Foundation Trust1

Westgate House1

Reports and published responses 2 reports

See individual reports that have raised this concern, and the actions taken in response

10 Nov2022
Cornwall and Isles of Scilly
Concerns raised1
1. Delays in availability of additional intermediate care bed capacity
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses

Department of Health and Social Care
Integrated Care Board (ICB
Stated actions 9
1. Integrated Care Board (ICB
  Optimise existing reablement capacity through a project with Prism and develop place-based collaboration, shared outcomes and coordinated hub arrangements.
2. Integrated Care Board (ICB
  Develop data to optimise intermediate-care productivity and inform the integrated-care-system strategy and future commissioning.
3. Integrated Care Board (ICB
  Commission community enablement services supporting up to 40 hospital discharges weekly.
1. Integrated Care Board (ICB
  Market-test additional regulated community enablement capacity to support 30 further weekly discharges.
2. Integrated Care Board (ICB
  Identify funding for an enhanced intermediate-care offer in community hospital beds.
3. Integrated Care Board (ICB
  Develop virtual wards delivering coordinated hospital-level care at home, including digital monitoring and intravenous treatment.
4. Integrated Care Board (ICB
  Train staff to identify suitable virtual-ward patients and increase occupancy of existing virtual-ward capacity.
5. Department of Health and Social Care
  Fund community beds, discharge lounges and ambulance hubs to reduce hospital flow and ambulance handover delays.
6. Department of Health and Social Care
  Make funding available to support adult social care, hospital discharge and timely transfer into community care.
AI-generated summary

David John Morganti and 3 others · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

The report concerns several deaths involving delays in ambulance attendance and/or admission to Royal Cornwall Hospital, including deaths after falls, head injuries and a stroke. The principal concerns are the ongoing delays caused by ambulances being held at the hospital, limited intermediate and social care capacity, and the risk that unsafe or inadequately staffed discharge arrangements may worsen patients’ health and lead to readmission.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Delays in availability of additional intermediate care bed capacity
Wider context from the report
“While the successful completion of the ICB’s building project will go a long way to improving the capacity of intermediate care beds in the county, it is likely to be many months, if not years, before that additional capacity becomes available. My central concern is how the delays that are currently manifest can be mitigated in the intervening months, particularly given the likely increase in demand for ambulances/hospital admissions during the winter months. ”
Source location
David John Morganti and 3 others · Prevention of Future Deaths report
Page 4 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Optimise existing reablement capacity through a project with Prism and develop place-based collaboration, shared outcomes and coordinated hub arrangements.

Verbatim wording from the response
“Cornwall Foundation Trust (CFT) are currently leading a project with Prism to optimise use of existing reablement capacity. We plan to deliver the discharge to assess aim whereby most post-acute medical episode assessments take place in the persons home/usual place of residence. Our place based iToCHs already re-coordinate the requests for care review, both in admission avoidance and discharge and we are working to develop a model of place-based collaboration in reablement with shared local outcomes. The work seeks to accelerate the development of this place-based service with an overarching co-ordination hub in place and a complex discharge team. We are developing data to ensure we are optimising productivity in the services we have and to inform the ICS intermediate care strategy and future commissioning plans.”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 2 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop data to optimise intermediate-care productivity and inform the integrated-care-system strategy and future commissioning.

Verbatim wording from the response
“Cornwall Foundation Trust (CFT) are currently leading a project with Prism to optimise use of existing reablement capacity. We plan to deliver the discharge to assess aim whereby most post-acute medical episode assessments take place in the persons home/usual place of residence. Our place based iToCHs already re-coordinate the requests for care review, both in admission avoidance and discharge and we are working to develop a model of place-based collaboration in reablement with shared local outcomes. The work seeks to accelerate the development of this place-based service with an overarching co-ordination hub in place and a complex discharge team. We are developing data to ensure we are optimising productivity in the services we have and to inform the ICS intermediate care strategy and future commissioning plans.”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 2 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Commission community enablement services supporting up to 40 hospital discharges weekly.

Verbatim wording from the response
“Intermediate care improvements: The ICB is currently commissioning community enablement capacity from Age UK, Humans Cornwall, a person-centred support brokerage and micro provider as well as CHAOS (Community Helping All Of Society) a domiciliary care”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 5 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Market-test additional regulated community enablement capacity to support 30 further weekly discharges.

Verbatim wording from the response
“A market testing exercise is currently underway to commission additional regulated community enablement capacity to support a further 30 discharges per week from February 2023. Finally additional funding has been identified to provide enhanced intermediate care offer in community hospital beds.”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 6 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Identify funding for an enhanced intermediate-care offer in community hospital beds.

Verbatim wording from the response
“A market testing exercise is currently underway to commission additional regulated community enablement capacity to support a further 30 discharges per week from February 2023. Finally additional funding has been identified to provide enhanced intermediate care offer in community hospital beds.”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 6 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop virtual wards delivering coordinated hospital-level care at home, including digital monitoring and intravenous treatment.

Verbatim wording from the response
“Further mitigation can also be seen through our use of virtual wards. CFT are developing the Cornwall and Isles of Scilly @home service which seeks to co-ordinate community services to offer hospital level care at home, including digital monitoring and intravenous treatments at home (virtual wards). We currently have a respiratory ward; a care home ward and our frailty ward has just commenced. Current capacity is respiratory (25); frailty (5) and care homes (20).”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 2 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Train staff to identify suitable virtual-ward patients and increase occupancy of existing virtual-ward capacity.

Verbatim wording from the response
“We are working with the acute ‘emergency village’ in RCHT and with CFT bedded care services to optimise a step-down model of care into this service. Once training complete, staff will be regularly working with colleagues to identify people suitable for the virtual ward service and increasing occupancy of the existing capacity. We expect to see this steadily increase over the next 2 months.”

Source location
Response from Cornwall and Isles of Scilly NHS
Page 2 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Fund community beds, discharge lounges and ambulance hubs to reduce hospital flow and ambulance handover delays.

Verbatim wording from the response
“The NHS is also focussed on reducing the numbers of ambulance handover delays to hospitals. Alongside direct improvement support to the most challenged trusts, an additional £250 million was made available to enable the NHS to buy up beds in the community to safely discharge thousands of patients from hospital, and capital for discharge lounges and ambulance hubs. These measures have helped improve flow through hospitals and reduce ambulance handover delays. This is on top of the £500 million already invested last year.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 21 November 2022
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Make funding available to support adult social care, hospital discharge and timely transfer into community care.

Verbatim wording from the response
“We recognise that discharging people once they no longer need acute care improves their outcomes and reduces the risk of medical complications. To improve rates of safe hospital discharge and increase patient flow, the government is making available up to £2.8 billion this year and £4.7 billion in 2024-25 to support adult social care and discharge. This is alongside £700 million invested this winter, on top of £1.6 billion over the next two years, to support timely and safe discharge from hospital into the community.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 21 November 2022
Open published response
23 Feb2016
Manchester South
Concerns raised1
1. Inadequate planning and unclear management standards for intermediate care
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
AI-generated summary

Edith Kirkham · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Edith Kirkham fell at home on 13 August 2015, broke her hip, underwent surgery and was later moved to intermediate care, where she was not mobilised despite medical advice; she died some days later in North Manchester General Hospital. Concerns included unclear management arrangements, inadequate staffing and handover, failures to read or understand clinical instructions, lack of physiotherapy, and missing records relating to her stay.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Inadequate planning and unclear management standards for intermediate care
Wider context from the report
“1. The intermediate care arrangement at Darnton House, I was informed, was a joint venture between L and M Health care and Tameside Hospital, but there seems to have been inadequate planning and unclear rules as to the level and type of management required for the patients/residents. Was the required standard that of a hospital or that of a care home. No-one seemed to know and this led to general uncertainty. ”
Source location
Edith Kirkham · Prevention of Future Deaths report
Page 1 · concerns
Open source report