Delivering care in every setting

An online survey was sent to chief executives, chief operating officers and finance directors of hospital, mental health and community trusts  on Wednesday 7th December and closed on Friday 9th December. We received 109 individual responses, representing 97 providers – 41% of the total provider sector. Responses were received from all provider types and all regions. The survey asked them about capacity and supply of ‘out of hospital’ care and the impact on their services – termed as ‘intermediate’ care.

It is important to note that the interpretation of ‘intermediate care’ by respondents was varied and therefore the services referred to here cover a broad spectrum that includes step down and step up bed capacity, as well as social and home care.

The survey showed:


  1. Mismatch between demand and capacity - The survey responses show that there is a clear mismatch between current demand for services in the community – such as step up and step down beds, rehabilitation services, care at home – and the ability of providers to meet it due to capacity shortages.
  2. Care at home – There was greater concern around lack of resource for providing care at home services than for intermediate care beds: “intermediate care capacity would be sufficient IF ongoing social and community care was available to support discharge from intermediate care beds.
  3. Variability – Many respondents mentioned variability within their area in the availability of services: “Capacity in [the county] is all in the wrong place with too much provision for the population needs in the south and not enough in the north.
  4. More complex needsWhile many referenced an increase in demand for many it was about increases in the acuity and complexity of patients requiring intermediate care: “The complexity of patients is much higher requiring specialist equipment and more intense therapy.
  5. Staffing – As with many areas of the NHS, staffing issues were raised: “A unit was closed over 12 months ago due to staffing issues” and “Main issue in this trust is difficulty recruiting and retaining district nursing staff.
  6. Reduced capacity – Many respondents noted that bed capacity had been reduced; this was across a range of services including nursing home beds, care home beds, intermediate care beds, community beds, and rehabilitation beds. Bed capacity has been lost due to decommissioning of services, lack of funding, lack of available staff and also restrictions placed on providers by the Care Quality Commission
  7. Transformation – When asked whether reinstating the lost capacity would enable them to meet the demand the majority said it would only partly meet demand or that transformation was needed to make it effective: “Not sure capacity ever met demand so would need more than previously but also its about the right type of capacity (social worker and package of care would make the biggest difference for this system).”

Download the briefing for the full survey results.