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.
INTRODUCTION
Who is this HICM for?
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.
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.
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, to reduce or eliminate their need for urgent care and long-term social care. Typically lasting no longer than six weeks, these services are provided free of charge.
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) and unregistered support workers (health and social care) play key roles in the delivery of rehabilitation and reablement. 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’6 set 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:
- Managing Transfers of Care (first developed 2015, latest refresh 2023)
- Reducing Preventable Admissions (latest refresh 2025)
- Using Data and Intelligence for Whole System Decision Support (2025)
- Improving the timely and effective discharge of people with dementia and delirium (2025)
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 only looked at people discharged from hospital who received contact with a community health service, therefore excluding people who received any form of community health service post-discharge, not just intermediate care.
Understanding current performance: the features of a high‑performing intermediate care system
Maintaining consistent flow through intermediate care is critical to achieving the best possible outcomes for people while making the most effective use of available resources, ensuring benefit is maximised across the population. This section sets out what effective intermediate care looks like in practice, to allow systems to assess their current status. Use your findings from Part B to decide which HICs in Part C to prioritise. Each feature described includes:
Descriptions of three maturity levels:
- Foundational, limited evidence of best practice
- Developing, working towards best practice
- Exemplar, regularly demonstrating best practice
- Data and intelligence that can be used to support self-assessment
- One or two targeted actions for colleagues seeking to take immediate action in this area
- Signposts to the relevant High Impact Change Areas in Part C
B1. Access to intermediate care
How people access intermediate care, from hospital and from the community, is a fundamental factor of effectiveness. Where access is fragmented, with multiple misaligned referral routes, duplicated assessments, and unclear criteria, the system loses time, capacity, and the confidence of referrers and service users alike.
An effective system has co-ordinated access arrangements, with clear referral criteria and processes. Effective intermediate care minimises the number of assessments (with ideally only one assessment to determine needs) and handoffs a person must undergo prior to entry.
[Link to case study]
Data to use
- Total capacity available in intermediate care services, and utilisation rates
- Utilisation rates of P1, and P2, P3 utilisation rates
- Number of people referred to intermediate care as a percentage of all discharges
- Number of people in hospital with no criteria to reside awaiting home-based intermediate care services
- Number of people who are stepped up to intermediate care from community settings
- Number of days from referral to commencement of service
Maturity spectrum
- Foundational: Multiple access points exist with separate criteria. Assessment duplication is common. No single view of available capacity.
- Developing: Referral access points are being rationalised. Shared criteria are agreed in principle. Work is underway to create a single view of capacity.
- Exemplar: One co-ordinated access point operates for both step-up and step-down. Shared triage enables real-time prioritisation and resource allocation decisions. Assessment duplication is eliminated through trusted assessor arrangements.
Targeted action
- Map out all of the access criteria for intermediate care services, and undertake an analysis to identify any significant gaps in the existing offer. Understanding this will either inform an improvement intervention, or create assurance that key population groups do screen in for intermediate care support. Review how easy it is for hospital based staff to make referrals into home based intermediate care services. If the criteria are too restrictive, or referral mechanisms too complicated, this will likely lead to an increase in referrals to bed based intermediate care services.
This action aligns with High Impact Change A - Establish operational grip and create the conditions for continuous improvement
B2. Setting goals and reviewing progress
A person-centred approach to goal-setting and progress review is central to effective intermediate care. Goals should be agreed with the individual and their carer within 24 hours of the service commencing, and communicated to all professionals involved in their support. Regular review through MDT meetings ensures that progress is tracked, goals are adjusted as needed, and people are stepped down from services when goals have been achieved. This supports appropriate length of stay in the service.
[Link to case study]
Data to use
- Proportion of people with goals set within 24 hours of service start
- Goal achievement rates
- People who leave intermediate care with no on-going care requirements
- People who leave intermediate care with reduced on-going care requirements compared to when they started intermediate care
- Duration of intermediate care compared to expected duration
Maturity spectrum
- Foundational: Goals are set inconsistently. Reviews are ad hoc. Insufficient involvement of the person and their family members/unpaid carers. Length of stay is not actively managed against expectations.
- Developing: A goal-setting process is in place with regular MDT review. Length of stay is monitored. Transition planning begins at admission.
- Exemplar: Goals are set within 24 hours, co-produced with the individual and their carer, and reviewed at every MDT with involvement of the person and their family members/unpaid carers throughout. MDTs routinely challenge over-prescription of care and promote independence. Transition plans are actively managed from day one. Length of stay consistently matches or improves on expected benchmarks
Targeted actions
- Define what a ‘goal’ is and ensure that the definition is made available to frontline staff; emphasise that a goal should be measurable and time limited. This definition should be owned by local professional leads and act as baseline for all professionals to work towards.
- Agree a standard for how regularly goals will be reviewed, so that the person in receipt of services and the team around them has a shared understanding, and who will lead on these reviews (so that these reviews are a core part of service delivery).
These actions align with High Impact Change A - Establish operational grip and create the conditions for continuous improvement
B3. Staff deployment and skills
The intermediate care workforce is diverse, spanning registered therapists, unregistered support workers, social workers, nurses, and many others. Staff are employed by a range of organisations. Effective intermediate care systems deploy their workforce in a way that maximises the value of each professional’s skills, matches capacity to demand, and promotes a culture of independence.
In the most effective systems staff may be deployed flexibly across care settings in response to demand and need, based on proactive decision making by the organisations involved.
A clear competency framework is essential so that teams can be clear on which members have the right skills and capabilities for any given requirement. This supports safety and quality, ensures that people are recognised for their expertise, and enables teams to identify gaps. Both registered and unregistered members of the team bring specific expertise.
Data to use
- Staff utilisation rates
- Skill mix ratios across pathways
- Agency spend as a proportion of workforce cost
- Staff absence rates
- Patient and carer experience
Maturity spectrum
- Foundational: Staff work within traditional team boundaries. Utilisation is not routinely measured. Professional standards are adhered to, but no wider competency framework is in place to support multidisciplinary working.
- Developing: Utilisation is monitored. Interdisciplinary working is encouraged. A competency framework is being developed.
- Exemplar: Staff are deployed flexibly across pathways based on demand. A competency framework ensures the right skills are matched to need.
Targeted actions
- Create spaces where multi-disciplinary teams can work together to help foster relationships and understanding. Understanding should lead to conversations about how to collaborate on shared cases
- Identify opportunities to implement a trusted assessor approach. In some systems, trusted assessment may be embedded and the action is to roll the approach out as far as possible; in other areas trusted assessment will be new. In this situation, it is advisable to choose a specific pathway as a starting point to develop learning.
These actions align with High Impact Change F - Mobilising a flexible intermediate care workforce across locations
B4. Person and unpaid carer experience
Effective intermediate care puts the person and their carers at the centre. This means explaining the ‘intermediate care deal’ at the outset: what intermediate care is, what it aims to achieve, how long it typically lasts, and how the transition out of intermediate care will happen. Setting people’s expectations helps them to be active partners in providing effective intermediate care services. For example, people and carers should be actively involved in goal-setting and have the opportunity to provide feedback on their experience.
Feedback from users and their carers should be routinely captured to inform development and service improvement initiatives.
[Link to case study]
Data to use
- Patient and carer feedback and survey outcomes
- Proportion of carers asked about their ability and willingness to provide care
- Complaints and compliments data
Maturity spectrum
- Foundational: Information about intermediate care is provided inconsistently. Unpaid carer involvement is minimal. Feedback is not routinely collected.
- Developing: People are given clear information about intermediate care at the start. Unpaid carers are consulted and informed of their statutory rights. Feedback is collected but not systematically acted upon.
- Exemplar: People and unpaid carers are fully involved in goal-setting and transition planning, their statutory rights are explained, as well as non-statutory support available. Feedback is routinely collected, analysed, and used to drive improvement.
Recommended actions
- Implement a user survey which is sent to everyone who has been through intermediate care, to ask about their experience and the experience of their carers. Initially this survey can be simple, but should include a question which asks people to rate their experience, to create a quantitative evidence base which can be tracked over time.
- Ensure that there is material available for hospital staff to explain the intermediate care offer, and set expectations appropriately. This material should help hospital staff to explain that intermediate care is time limited support aimed at helping with tasks of daily living and enabling independence.
These actions align with High Impact Changes A and B.
| HIC A | Establish operational grip and create the conditions for continuous improvement |
| HIC B |
Committed local leadership, shared accountability, and system metrics
|
B5. Focus on outcomes
The ultimate measure of effective intermediate care is whether people recover and retain as much function and independence as possible. This means measuring not just throughput and length of stay, but changes in independence levels, successful return home from bed-based care, use of ongoing home care, and avoided admissions and readmissions.
Data to use
- Independence levels before and after intermediate care
- Proportion of people who live independently at home following intermediate care
- Long-term care (care home and home care) uptake following intermediate care
- Acute hospital admission and readmission rates
- Avoided acute hospital admissions (noting the difficulty of measurement)
Maturity spectrum
- Foundational: Outcome measurement is limited to length of stay and throughput. Independence outcomes are not routinely tracked.
- Developing: Independence outcomes are measured for some pathways. Readmission rates are monitored. There is growing attention to outcomes-based commissioning.
- Exemplar: Comprehensive outcome measurement is embedded, covering independence, readmissions, long-term care uptake, and patient experience. Outcomes data drives commissioning decisions and service improvement.
Targeted action
- As the basis of an approach to measuring outcomes, start by asking users and carers to explain what matters to them. The independence metrics used by services will be proxy measures for the experience of people using the services. Conversations with users and their carers allow each metric to be clearly linked to lived experience.
This action aligns with High Impact Changes A and B.
| HIC A | Establish operational grip and create the conditions for continuous improvement |
| HIC B | Committed local leadership, shared accountability, and system metrics |
B6. Creating the right environment for intermediate care
The physical environment in which intermediate care is delivered has a significant impact on outcomes. Home-based settings should be safe and conducive to recovery, with environmental barriers addressed through timely access to home adaptations and equipment. Bed-based settings must be set out to promote independence, not replicate a long-term care culture. For example, it is often the case that intermediate care beds are ‘spot’ purchased with residential care settings. In this context it is extremely challenging to ensure that the person in that bed gets the right rehabilitative input, rather than receiving care similar to permanent residents. A group of defined beds commissioned through a block contract arrangement are more likely to offer the holistic rehabilitation and reablement input required and lend itself to more effective provision of the wraparound support that can be valuable in promoting recovery and independence.
By right sizing the number of intermediate care beds, systems can shift funds towards home-based intermediate care, allowing more people to achieve better outcomes by being supported in their own homes.
[Link to case study]
Maturity spectrum
- Foundational: The environment does not allow for effective rehabilitation and reablement . Transition planning is reactive.
- Developing: Rehabilitation and reablement principles have been adopted. Expected dates of transition are set.
- Exemplar: All settings operate with a rehabilitation and reablement mindset, with a suitable environment to promote independence. Therapy input is available daily if required. Transition plans are in place from day one.
Targeted actions
- Engage with your Integrated Community Equipment Service provider to ensure that delivery timescales align with the expected commencement times for intermediate care services, and that people resident in care homes can get access to equipment. This prevent delays in starting intermediate care and facilitates discharge.
- Undertake an audit of Pathway 2 beds to check whether their physical environment is set up to facilitate and enable a rehabilitative approach, and whether the staff around these beds have the right skills and knowledge to work in this way.
These actions align with High Impact Change C - Joint commissioning, shared design principles, and a funding framework.
B7. Managing the intermediate care resource together
To get the most value from intermediate care resources — beds, home-based capacity, workforce, and budget — they must be managed collaboratively across the system. This means understanding demand, acuity/complexity of that demand, workforce capacity, and lengths of stay across all pathways, addressing barriers to move-on, managing the total funding for intermediate care, and using resources flexibly to respond to spikes in demand.
Capacity should be understood in terms of intensity as well as volume: not just how many beds or people are being supported, but the nature and frequency of the support being provided.
To identify additional or specialist capacity requirements, such as dementia care, population health management data should be used.
Data to use
- Service demand
- Workforce capacity
- Length of stay by pathway (home-based and bed-based)
- Bed occupancy and throughput
- Costs per episode of care, and costs to deliver particular outcomes, to support evaluation of value for money
- Average weekly cost of a care package
- Intensity: days between first and second care contact
- Availability of community equipment
Maturity spectrum
- Foundational: Each organisation manages its own capacity. There is no shared view of demand or utilisation. Resources cannot flex.
- Developing: A shared view of capacity and demand is being established. Length of stay is monitored. Joint budget discussions are taking place.
- Exemplar: Resources are managed jointly with a single shared view of capacity, demand, and cost. Capacity flexes in response to demand. Funding planning is long-term and aligned to improvement programmes.
- Targeted action
Identify all of the system-wide spend on the existing intermediate care offer, and quantify the total capacity that this resource is purchasing. This baseline spend data should enable an informed discussion about the value and benefit achieved, and allow for honest conversations about spend which is not achieving clear benefits.
This action aligns with High Impact Changes B and D.
| HIC B | Committed local leadership, shared accountability, and system metrics |
| HIC D | An integrated delivery structure with clear, delegated decision-making |
B8. Reviewing data regularly
Productive intermediate care requires a coherent set of metrics that spans inputs, activities, outputs, outcomes, and system impacts. The following framework provides example data points.
- Inputs: service projected demand, beds, home-first capacity, rehabilitation and reablement hours, therapy hours, workforce, skills mix, equipment
- Activities: home-first assessments, therapeutic assessments, MDT triaging, reablement sessions, therapy interventions, personal care plans, carer support plans, reviews
- Outputs: episodes of intermediate care completed, bed-days delivered, starts within 24 hours, length of stay vs expected, avoided delays, bed occupancy, functional improvement
- Outcomes: independence levels, achievement of goals, improved mobility, activities of daily living assessments, reduced care package, avoided residential care
- System impacts: timely access, reduced hospital length of stay, reduced delays, reduced admissions and readmissions, reduced long-term care, reduced GP and community nursing demand, survey outcomes and feedback
Additional recommended metrics include: average weekly cost of a package, intensity and duration of intermediate care, waiting times (referral to assessment and assessment to service), and alignment with ASCOF metrics and the Better Care Fund framework 2026 to 2027.
Relevant ASCOF metrics include:
- The proportion of people who received reablement during the year, who previously were not receiving services, where no further request was made for ongoing support
- The proportion of people aged 65 and over discharged from hospital into reablement and who remained in the community within 12 weeks of discharge
- The proportion of people aged 65 and over discharged from hospital, who received reablement services
Maturity spectrum
- Foundational: Each organisation reviews its own data separately, and uses this data to drive independent decision making. Data is only shared infrequently between partners, and there is little evidence that this impacts on decision making.
- Developing: Data is regularly shared between partners, but there is insufficient trust for partners to collectively review one data set. Data sharing does impact on decision making, but not routinely.
- Exemplar: All system partners are reviewing one consolidated set of data metrics, including both leading and lagging metrics. Partners trust this data, and is it the evidence base for key decisions. Data creates accountability and responsiveness.
Targeted action
- Convene a workshop of system partners to agree a long-list of shared metrics which describe the operational effectiveness and impact of intermediate care. Agree a process to share this data and agree a rhythm for sharing data. Ensure that there is a space in the system where these agreed metrics can be discussed. The behaviour of sharing and discussing one agreed data set will help drive partners towards a shared understanding, and the long-list will be refined.
This action aligns with High Impact Changes B and D.
| HIC B | Committed local leadership, shared accountability, and system metrics |
| HIC D | An integrated delivery structure with clear, delegated decision-making |
From understanding maturity to taking action
Part B helps systems understand what effective intermediate care looks like and assess how close they are to this in practice. Part C then builds on this by setting out six High Impact Change areas that respond to the most common gaps and challenges identified through the maturity framework. Systems can use their self‑assessment from Part B to to plan and sequence the actions in Part C in a way that supports whole‑system improvement.
This section sets out six High Impact Change (HIC) areas with tangible, step-by-step actions. Each area follows a consistent structure: the problem; reflections from intermediate care professionals; recommended actions; potential impact. All actions set out here are recommendations based on engagement with the sector.
The six change areas are interdependent. Effective leadership and governance (HIC B) must underpin joint commissioning (HIC C). Operational grip (HIC A) is a prerequisite for data-driven improvement. Systems should sequence their work accordingly rather than treating all six areas as separate asks.