This HICM forms part of a series all focused on giving clear recommended actions for systems to take on cut-crossing thematic issues which are recognised challenges in health and social care . It has been designed in collaboration with a Steering Group made up of senior leaders from health and social care, and a Reference Group made up of senior managers delivering, commissioning, and designing intermediate care services.
INTRODUCTION
Who is this HICM for?
This HICM is intended for use by professionals at all levels in health and care systems who have responsibility for either planning, commissioning or delivering intermediate care. This includes people in NHS bodies (including ICBs, NHS trusts and NHS foundation trusts); local authorities; health and social care providers; primary care; and voluntary, community, faith and social enterprise (VCFSE) organisations.
For bed-based intermediate care, NHS community bed providers are expected to review and act on the requirements set out in the Delivery Model for Community Beds, including developing an improvement plan; non-NHS providers are also encouraged to take part and access the resources available. This document does not intend to restate the requirements set out in the Model, but instead focuses on the whole system conditions, leadership and improvement actions required to enable effective intermediate care across both home-based and bed-based pathways.
How to use this HICM and structure of the document
This HICM is designed to support local system partners to achieve the most significant impact from intermediate care by maximising effectiveness and optimisation of resources. It is structured in three parts:
- Part A, Context and Case for Change: defines intermediate care, and sets out the case for change
Parts B and C are designed to work together. The maturity framework in Part B identifies improvement needs; Part C provides the improvement response. Systems should use their Part B self‑assessment to determine which areas require the most focus, informing their application of the High Impact Changes in Part C.
Part B What effective intermediate care looks like (understanding current performance): sets out the features of a high‑performing intermediate care system using a maturity framework. It supports local systems to build a shared understanding of what good looks like and to assess their current position. Part B helps systems to:
- Assess their level of maturity across the key components of intermediate care
- Identify strengths, gaps, and unwarranted variation in provision
- Understand where performance is limiting flow, productivity, or outcomes
- Create an evidence‑based view of priority areas for improvement.
The maturity framework is therefore a diagnostic tool, helping systems understand where they are today and what needs to improve to deliver effective intermediate care.
- Part C, Taking whole-system action (delivering improvement): translates the findings from the maturity framework into action through six High Impact Change areas:
HIC |
HIC Area |
| A | Establish operational grip and create the conditions for continuous improvement |
| B | Committed local leadership, shared accountability, and system metrics |
| C | Joint commissioning, shared design principles, and a funding framework |
| D | An integrated delivery structure with clear, delegated decision-making |
| E | Scaling step-up care and admission avoidance |
| F | Mobilising a flexible intermediate care workforce across locations |
These provide a practical, structured approach to improvement, focused on productivity, flow, and outcomes. Part C supports systems to:
- Address the most common gaps identified through the maturity framework
- Take clear, step‑by‑step actions that support whole‑system working
- Sequence improvement work in a way that is realistic and sustainable
- Move systematically from current maturity towards high‑performing intermediate care.
The model is intended to be applied collaboratively across organisations, with co‑production involving clinicians, practitioners, and people with lived experience of intermediate care services.