The development of intermediate care services in England.

The origins of intermediate care as a health policy in England are reviewed. The randomized controlled trial (RCT) evidence for the various intermediate care service models is discussed from the perspectives of clinical, service and economic outcomes. This evidence base suggests that the hospital-at-home approach is currently the best RCT supported intermediate care service model. It is argued that intermediate care in England has yet to fulfil its expectations. Changing staff skills and attitudes has proved a challenge, and the integration of intermediate care with mainstream services has been especially difficult. New national guidance has been produced that is attempting to refocus intermediate care its intended target group of frail older people, and not to specifically exclude older people with mental health problems.