Halton Borough Council’s case study showcases the Halton Intermediate Care and Frailty Service. The intermediate care service was co-designed with system partners to address demand pressures and develop effective pathways to support a ‘home first’ approach. The model has led to the avoidance of significant costs through reduced packages of care and improved outcomes for people.
Intermediate care is a short-term service aimed at supporting people to stay independent for as long as possible, to live and receive care in their own homes and to avoid being admitted or readmitted to hospital or residential care until they need to be. CIPFA’s Managing rising demand in adult and children’s social care (2024) contains several examples of how councils are controlling rising levels of need through investing in intermediate care. Effective intermediate care improves outcomes for people, supports safe and timely discharges from hospital and can have a positive impact on council finances.
The challenge
With a population of around 129,000, Halton Borough Council is a small unitary authority in the county of Cheshire.
As with all local authorities, the funding available to Halton Borough Council has declined significantly since 2010; however, there remains the need to continue activity on meeting people’s assessed needs in support of the council’s adults directorate’s vision “to improve the health and wellbeing of Halton people so that they live longer, healthier and happy lives”, while also reducing costs and delivering value for money.
System challenges that resulted in the need to develop and implement a new approach to intermediate care within the borough included significant demand pressures being exerted on the borough council from various sectors, including the local acute hospital trusts, which contributed to much poorer flow through services, nationally mandated work on urgent and emergency care improvements, the national drive for discharge to assess (D2A)/home first models, the local over reliance on bed-based services for rehabilitation, maintaining people in their own home rather than admitting them to long-term residential care, and the high number of people waiting for domiciliary care.
The action
Halton Borough Council is part of the current Cheshire and Merseyside integrated care system partnership. Adult social care in Halton has an excellent track record in working in partnership/collaboratively to deliver on Halton’s strategic approach to the commissioning and provision of services.
In developing HICaFS, led by Halton Borough Council, key partners from across the system (eg community health service) worked together to co-design the new model for intermediate care provision in the borough.
This involved:
- establishing a steering group and associated operational group to progress development of the model
- establishing formal care pathways to support D2A/home first approaches and organising service responses along those pathways
- emphasising the importance of good multi-disciplinary planning with clearly set therapeutic goals and ensuring feature of the associated pathways
- agreeing the shift of investment from intermediate care bed-based services to home-based services, including domiciliary care provision.
The outcome
HICaFS aims to ensure a rapid screening, assessment and intervention service. It aims to ensure the seamless and safe management of referrals for people requiring adult community services, either to potentially prevent an admission to hospital, support early discharge or coordinate care ‘closer to home.’ There is strong co-ordination between intermediate care, hospital discharge and reablement through this service, which strengthens the communication and overall co-ordination between health and social care services.
Benefits to individuals who pass through this service include:
- reducing the number of inappropriate referrals into services: right care first time
- reducing duplication of assessments and visits to people’s homes through better care co-ordination
- facilitating discharge and preventing unnecessary admissions.
Benefits to the Halton system include the following:
- An increased number of admissions and flow through intermediate care services. For example, as part of the urgent and emergency care improvement programme, for the Warrington Hospital footprint, a target of 217 admissions to reablement services was set for 2024/25 – total admissions made was 271.
- A reduction in length of stay on reablement – rolling 12-month target was set of 36.7 days. At the end of March 2025, this stood at 33.1 days.
- During 2023/24, the proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services stood at 96.4%, higher than peer neighbours the North West and England.
As a result of reablement intervention, during 2024/25, approximately 350 packages of care were reduced, which resulted in cost savings of circa £1.64m.
Supporting people to stay at home minimises the need for admission to hospital. During 2024/25, circa 2,500 people were seen by Halton’s Urgent Community Response (UCR) service, part of HICaFS, which resulted in only circa 12% of individuals being admitted/readmitted to hospital. A higher proportion of older adults (aged 65 and over) were supported to live at home rather than admitted to a residential or nursing care home.
As at the end of February 2025, the total number of older people aged 65 and over in receipt of long-term packages of care and supported to live at home was 40.9% compared with 35.9% of individuals living in residential and nursing care homes.
Reflection
Lessons learned include ensuring:
- effective leadership is in place to support the delivery of the strategic intention
- partners are on board and sign up/support the approach from the beginning of the case for change in addressing the challenge/issue
- appropriate engagement with elected members to support effective political leadership and support the development of new approaches
- there is the appropriate infrastructure in place to support development/implementation
- there is clear alignment between performance, feedback and approach to triangulate information and support development.
We need to be continually mindful and assess remaining challenges both nationally and regionally that may impact on services provided – for example, continued political interest in the NHS.
We’ll continue to work with national and regional partners and engage in programmes of work to support continued improvement in health, care and support, eg urgent and emergency care improvement programmes, and to exploit opportunities to make further improvements to processes and pathways, which will impact positively on the service provided to Halton residents.
The approach taken and model in place could be replicated elsewhere.
7 July 2025
Contact information
Susan Wallace-Bonner
Executive Director, Adult Services
Susan.Wallace-Bonner@halton.gov.uk
