What's all the fuss about intermediate care?
The population is getting older. Already two out of three hospital patients are 65 or over and intermediate care is seen as an important way of improving services for the elderly.

Is it new?
Despite the seemingly new creation of the "big idea" this year by ministers, intermediate care is nothing new. Also called "step-down" care, it is about providing services to ease the transition from hospital to home and from medical dependence to functional independence. But while the national beds inquiry, launched early in 2000, found some good examples of intermediate care, services were patchy and often set up on a temporary basis to get through winter crises. What ministers want now is to set up a more permanent tier of services that will operate all year round.

Will it end 'bed blocking'?
It is certainly intended to free up hospital beds for more appropriate use. For older people, about 20% of bed days could be termed inappropriate if alternative facilities were in place. As well as representing poor care for patients, keeping patients in hospital beds longer than necessary is also expensive - costing up to £1,200 per bed per week.

How will it work?
A range of ideas are being examined. Medically stable patients could be transferred to community hospitals, special nurse-led care units or residential homes for rehabilitation, before finally being discharged to their own home. Or patients could be discharged home but provided with intensive support including nursing and therapeutic care. But intermediate care is about much more than ensuring faster discharge.

Like what?
For a start, ministers are also keen to avoid inappropriate hospital admissions in the first place. Rapid response teams may be set up that could assess, diagnose and treat patients at home.

What differences will we actually see?
According to last summer's NHS plan there will be an extra 5,000 intermediate care beds. Some will be in community hospitals, others in special wards in acute hospitals and some in purpose-built new facilities or redesigned private nursing homes. The plan also aims to introduce 1,700 extra non-residential intermediate care places.

Where will the money come from?
The NHS plan claims to provide an extra £900m for intermediate care by 2003-04. It is understood that more than £500m of this may have to come from local councils, which run social services.

Has anything been spent already?
Health authorities were expected to spend up to £150m this year from general allocations on intermediate care. And a further one-off sum of £52m was also allocated in the summer to help health bodies prepare for winter. Next year a further £38m is being added, meaning that health authorities and primary care groups will be expected to plough at least £188m into joint investment plans with councils. Guidance on intermediate care due out early in 2001 will unveil further investments for 2002-03 and 2003-04.

What about councils?
This is where the government's pledge to spend an extra £900m may become tougher. For a start, councils are currently seeking clarification from ministers on how much local government is expected to pour into intermediate care. But identifying the amount is just part of the battle. Although councils receive nominal spending assessments for each of their main services, including personal social services, they actually receive a grant covering all services and are largely free to spend this as they see fit, in line with local priorities.

Can't the money be ring-fenced?
To an extent. At the end of November, health secretary Alan Milburn announced an extra £100m for social services departments to spend in 2001-02. To receive the funds to help develop intermediate care, social services departments will have to agree on joint plans with NHS partners. But some authorities say that this increase is matched by a decrease in their spending assessment for services for older people. The government, they say, is giving with one hand and taking away with the other.

Can social services afford to expand intermediate care?
It will be extremely challenging. Social services directors are already predicting overspends this year. And with many spending well over their standard spending assessments as it is, funding new developments for the elderly is likely to be at the expense of other front line services.