PART A: Context and case for change

A1. Definition of intermediate care

Intermediate care – which may be health or social care, or a combination of health and social care – is an umbrella term for short-term, community-based services that help people recover and rebuild their independence. Also known as rehabilitation, reablement and recovery services, these may be home-based or community bed-based, provided on a step-up or step-down basis, and integrated with wider services, to reduce or eliminate their need for urgent care and long-term social care.

Typically lasting no longer than six weeks, intermediate care is tailored to a person’s needs and usually includes a combination of therapy-led rehabilitation and/or reablement assessments and interventions, as well as other assessments and interventions to aid recovery. Registered therapists (e.g. physiotherapists, occupational therapists and speech and language therapists) lead rehabilitation and reablement and unregistered support workers (health and social care) play key roles in delivery.. A range of other staff groups may also be deployed flexibly as necessary to support the recovery process, such as doctors, nurses, pharmacy professionals, care workers, social workers and housing/homelessness workers.

Delivery of intermediate care takes place in a person’s usual place of residence (e.g. own home or care home if they are a resident) in alignment with the home-first approach, and/or in a community bed-based setting (e.g. community hospital, care home or other bed-based facility). Referrals may be on a step-up basis from the community (e.g. general practice, community health services or adult social care), or on a step-down basis from inpatient settings or hospital at home (virtual ward) services.²

The HICM contains a greater emphasis on intermediate care delivered in a step‑down context – supporting people to regain independence following a hospital stay – than on step‑up provision, which focuses on preventing hospital attendance and admission. This reflects the sustained operational focus on hospital discharge in recent years, which has resulted in a more developed evidence base for effective step‑down provision.

The learning reflected in the HICM can inform the ongoing development of both step‑down and step‑up intermediate care. This approach is consistent with the commitment set out in the 2026 Neighbourhood Health Framework that “the NHS will work with local authorities and other partners to increase intermediate care capacity” across step‑up and step‑down pathways.³

A2. The issues that this HICM will address

In 2025, the Government set a clear direction of travel for health and care in England, defined by three strategic shifts: from analogue to digital, from hospital to community, and from treatment to prevention.3 These shifts were articulated in the 10 Year Plan for Health and reinforced by subsequent documents such as the Neighbourhood Health Framework. Together, these shifts demand a transformation in how intermediate care is planned, commissioned, and delivered.

In the longer term, intermediate care is a central component of the move towards a neighbourhood health service. The Neighbourhood Health Guidelines 2025/26 emphasised that local systems should deliver short-term rehabilitation, reablement and recovery services, taking a therapy-led approach, ensure referrals can be made directly from the community as well as from hospital, and implement good operational case management systems and measure outcomes.⁴ The 2026 Neigbourhood Health Framework asks system partners, in the 2026/27 financial year, to “agree an initial plan to reduce non-elective admissions and bed days by increasing the capacity of urgent, rehabilitation and reablement services at neighbourhood level, based on patient risk register analysis”.⁵

Challenging the ‘myths’ about intermediate care

Before setting out the case for change, it is helpful to address some widely held misconceptions about intermediate care that can constrain ambition and divert effort away from areas of greatest impact. The following ‘myths’ were highlighted at an intermediate care Leadership Summit hosted by the BCF Support Programme in November 2025, and reflect learning from work with health and social care systems undertaking intermediate care transformation.

The 'myth'	The reality
Intermediate care only provides capacity to alleviate pressure on acute hospitals	Intermediate care is about improving people’s outcomes by enhancing independence
Intermediate care capacity is well understood, and easy to quantify	There is often a lack of clarity about how much capacity is available and where it is
Intermediate care services form one single offer	Intermediate care is made up of a series of distinct but overlapping services
Intermediate care is always cheaper than hospital care	Intensive intermediate care in certain settings can be of a similar expense in the short-term, but, if optimised, the longer-term cost benefit to the person and the system can outweigh costs.

Where we are now: intermediate care is not fulfilling its potential

‘Fit for the future: 10 Year Health Plan for England’⁶set out that intermediate care services will be fully integrated with neighbourhood health services and will expand overall capacity through a transition to more intensive, but shorter, periods of rehabilitation and recovery, enabled by joint funding through the Better Care Fund.

Currently intermediate care is not fulfilling the potential that it has to improve people’s outcomes and levels of independence. Nor are people’s overall outcomes being consistently monitored.

A 2024 study published by the Health Foundation⁷ found that:

Only 5% of hospital discharges were to intermediate care
37% of patients stepped down to intermediate care returned to hospital within 6 weeks
66% of those discharged from hospital to intermediate care were already receiving community support before their admission
31% of intermediate care users have only one care contact per week. These statistics suggest there are opportunities for more effective and intensive intermediate care.⁸

For intermediate care to reach its potential it has to materially improve independence outcomes for users, and as a by-product of this, reduce the long term demand in health and social care services. Getting intermediate care right could reduce spend on long-term care by £3.4billion per year⁹.

Five principal challenges

The HICM Reference Group identified five major challenges to overcome to make intermediate care more effective:

Lack of shared accountability and risk/benefit sharing: Partners often lack clear mechanisms to hold one another to account for system‑wide outcomes, alongside limited arrangements for sharing the risks and benefits of investment across organisations. This can result in duplication of services and provision that is not consistently aligned around people’s needs.
Poor quality data that is insufficiently focused on patient outcomes: Data collection frequently prioritises operational metrics rather than meaningful outcomes related to independence and wellbeing. This limits the ability to understand impact, compare performance, and identify where improvement is most needed.
Disjointed commissioning and fragmented funding models: Separate funding streams and contractual models lead to duplication, limit visibility of demand and capacity, and create gaps across the intermediate care pathway, resulting in inefficient use of resources.
Limited availability of effective step‑up intermediate care: In many areas, there is insufficient provision of proactive, community‑based intermediate care that can prevent, reduce, or delay the escalation of care and support needs before a crisis occurs.
Insufficient integration across service delivery: Services often operate in isolation rather than as part of a co-ordinated multi-disciplinary team system, limiting opportunities for innovation, shared learning and continuous improvement.

A3. Patient and carer experience — what people tell us

This HICM has drawn on a body of evidence on the views of people using intermediate care services and their carers, including 115 interviews with people recently discharged from hospital across six ICSs (2023–2025), 39 interviews conducted by local Healthwatch organisations, the Think Local Act Personal ‘Making It Real’ statements, and independent work led by Carers Trust and Carers UK.

Analysis of this evidence highlights a consistent set of priorities expressed by people using intermediate care services and their carers:

People and carers being active participants in decisions about ongoing care and support
Timely discharge from hospital and access to support from the community
Support to regain independence, with assurance that their wishes and circumstances are being listened to
Effective communication and co-ordination between services, and with people and carers
Consistency of staff supporting people at home
Smooth, well-planned transition from intermediate care to any longer-term care
Staff having time to care. These findings have informed the HICM’s emphasis on shifting from capacity management in intermediate care, to a focus on outcomes, independence, and the role of people and carers in their own recovery.

A4. Previous High Impact Change Models

This model builds on and complements four previous HICMs:

A5. Acknowledgements

[Details of Steering Group, Reference Group, and 1:1 participants to be added.]

The development of this HICM has been informed by extensive engagement with local system leaders, whose time, experience, and insights have been invaluable in shaping the model. Their contributions have provided a clear understanding of the practical challenges faced across systems and have helped to identify the key areas for improvement set out in this HICM.

^{2 NHS England » Standardising community health services – core component descriptions}
^{3 Fit for the future: 10 Year Health Plan for England}
^{4 NHS England » Neighbourhood health guidelines 2025/26}
^{5 Neighbourhood health framework - GOV.UK}
^{6 Fit for the future: 10 Year Health Plan for England (accessible version) - GOV.UK}
^{7 Are intermediate care services stretched too thin? briefing}^{8 It is important to note that this study looked at all people discharged from hospital who received contact with a community health service and therefore included people who received any form of community health service post-discharge, not just intermediate care.}