As the older population inevitably ages and numbers rise, frailty will become more common. However, it’s not inevitable, so it’s also crucial for older people and for health and social care resources that resources are managed in a multi-disciplinary way.
The Acute Frailty Network is an NHS Improvement programme developed and delivered by NHS Elect to work with frontline teams to understand what support they need to improve acute services for frail older people. It was set up four years ago following the publication of the first Silver Book which ADASS collaborated with and was presented at the ADASS Spring seminar in 2012.
The programme currently has 79 sites across the country with a further nine being developed. A strong focus on multi-disciplinary teams and a whole system approach is increasingly being developed as the ICSs and STPs are rolled out. The Acute Frailty Annual Conference on 27 June was a great opportunity to show case the huge progress being made by local pilots.
The day kicked off with an excellent session from Professor Martin J Vernon, the well-known national clinical director for older people at NHS England and currently leading national work on a Person-Centered Integrated Care. He spoke about the importance of moving towards whole systems and social care being an integral part of that system. He was followed by another excellent presentation from Dr Lucy Abbott, consultant physician and geriatrician from Frimley Health NHS FT. Dr Abbott was eloquent in regarding social work and social care as essential to their work and the outcomes they achieve across the nine Councils covered by the service.
Professor of acute geriatric care at the University of Amsterdam, Bianca Buurman, joined the conference in the afternoon to speak about the impact that staying in hospital too long has on an older persons functions, and the consequences this has on their independence and care. Crucially, she also talked about her research into older people’s functioning prior to going into hospital and again three months after discharge. The ongoing impact on older people’s levels of functioning after unplanned admission can be significant both for the older person and on social care provision and cost.
The final presentation of the day came from Dr Matt Thomas, consultant geriatrician at Poole Hospital and the Royal Bournemouth and Christchurch Hospitals NHSFT about Same Day Emergency Care (SDEC) programme.
The ambitions from the NHS Long Term Plan note that all hospitals with a 24 hour A&E will provide SDEC at least 12 hours a day, 7 days a week by September 2019 and an acute frailty service at least 70 hours a week by December 2019, with the aim to complete a clinical frailty assessment within 30 minutes of arrival in the A&E.
This will have significant implications for all community-based services, including social care. As Dr Thomas spelt out, older people who would previously have been admitted for assessment will now be assessed, treated and sent home within 24 hours. The benefits for older people will be significant. There will be less loss of functionality and disorientation, they’ll back home quicker, which is where most older people want to be, less disruption in their services and perhaps most important of all, the option of dying at home rather than in a hospital setting.
It will also substantially reduce delayed transfers of care due to clinical reasons. One of the main reasons for these is the admitting clinician’s desire to have a secondary specialist referral. This will still happen but from a home base as an outpatient.
This year, Denise Radley, who is leading for ADASS on the national work updating the Silver Book to ensure joined up commissioning arrangements across the whole system, attended the conference. Denise said: “There was a clear message at this year’s conference that the Acute Frailty Network has identified that working together in multi-disciplinary teams leads to the best results for improving lives for frail older people.”