For bed based intermediate care
For bed based intermediate care, expected operational standards are set out in the Delivery Model for Community Beds. These requirements apply to all NHS providers delivering community bedded care.
The problem
Intermediate care is often thought of as predominantly associated with hospital discharge. Step-up care — where individuals receive increased support from the community before their needs escalate to hospital or care home admission — is considerably less developed, often lacking dedicated protocols, integration, and resourcing.
In most systems, as discharge demand grows, step-up intermediate care capacity is increasingly consumed. This creates a self-reinforcing cycle, where the capacity of step-up to contribute to reducing overall demand remains underdeveloped. There is significant attention already on services before the hospital front door, including Urgent Community Response and reducing avoidable ambulance conveyance. The opportunity for intermediate care is to complement these by providing a robust step-up pathway in response to an escalation of needs or for people at risk of deterioration.
The Delivery Model for Community Beds sets out the expectation that partners will work together to evolve community services for the future, shifting the emphasis of bedded care provision from reactive step-down to proactive step-up services that underpin patient-centred community care and support acute admission avoidance.
Voices from stakeholders
“We don’t focus on step up and prevention enough. We are dominated by reactive approaches to hospital discharge”.
“We’ve done a lot of analysis on our data, and it’s stark — we have extremely limited capacity to support community step up, as our services are increasingly being taken up by discharge”.
Actions
E1. Create operational and strategic space for step-up
| Step | Action |
| Step 1 | Analyse the current balance of step-up versus step-down capacity and demand across the system. |
| Step 2 | Identify where proactive action could have avoided escalation — using multiagency reviews and data analysis to find missed opportunities. |
| Step 3 | Consider the proportion of community intermediate care capacity for step-up referrals, ensuring a whole system effort to prevent discharge demand consuming all available capacity. |
| Step 4 | Monitor the protected capacity to ensure it is not eroded by step-down pressure. |
| Step 5 | Use population health management approaches to identify people at risk of deterioration who could benefit from proactive interventions, with a clear link to the productivity impact for intermediate care. |
E2. Test and evidence step up intermediate care approaches at scale
| Step | Action |
| Step 1 | Convene multiagency reviews to identify step-up opportunities and where proactive action could have avoided admission. |
| Step 2 | Design and test new solutions through multidisciplinary teams, supported by dedicated workstreams on finance, benefits, and outcomes. |
| Step 3 | Build links with complementary programmes: Urgent Community Response, falls prevention, virtual wards, and VCFSE partnerships. |
Productivity impact
By preventing avoidable admissions, systems can reduce acute pressure, reduce long-term care demand, and improve outcomes for individuals.
[Link to case study]