2018/19 Managing Frailty conference review

On 7th of February 2019, we held the Managing Frailty and Delayed Transfers of care in the Acute Setting conference. The conference was a great opportunity for showcasing the good practice from our membership and presenting the findings from this years project, as well as hearing a national update from the GIRFT Geriatric Medicine Team and a review of the Wessex Frailty Audit. We were also pleased to welcome the British Geriatrics Society and the Acute Frailty Network who exhibited throughout the day.

First to the stage was Dr Adrian Hopper, who provided an update from the GIRFT Geriatric Medicine team, the aim of which is to tackle unwarranted variation and improve the quality of patient care. This workstream is in its’ infancy, with emerging themes including hospital deconditioning, acute frailty response and options in End of Life Care. The NHSBN have collaborated with the GIRFT Geriatric Medicine team to reduce data burden and provide analytics to the GIRFT data packs.

Following this, we heard from the Wessex AHSN team, who presented their Wessex Frailty audit findings, with a particular focus on collaboration in practice. Kathy Wallis, Associate Director of Strategic Programmes, spoke about their focus on innovation and spread of good practice, as well as the influence of Wessex AHSN and opportunities to collaborate to reach more people. One such collaboration is with the NHSBN, which enabled the Wessex Frailty audit to achieve 100% engagement with Wessex hospitals.

We then heard from the NHSBN team, who presented the Managing Frailty and DToC benchmarking findings, and service user audit. Some of the findings included:

  • 64% of Trusts have a Frailty unit, and 93% of these Frailty units use CGA.

  • Senior medical cover to frailty units per day:

    • 12 hours - Monday-Friday

    • 7 hours - Saturday-Sunday

  • 86% of delayed transfers of care were attributable to people age 65 and over in 2017/18.

After a networking lunch, we were welcomed back to an afternoon of good practice. We started the sessions with an overview of the End PJ Paralysis campaign, by Dr Amit Arora, Consultant Geriatrician and Associate Medical Director, University Hospitals North Midlands. The campaign had the aim of a nationwide 70-day challenge, to get 1 million patients dressed in day clothes and mobilised. Despite missing their target 1 million patients, the campaign demonstrated the effects of getting up, getting dressed and moving. The activity reversed the negative effects of deconditioning in a hospital setting.

Following this, Dr Louise McCusker, Hillingdon Hospitals shared their Acute Frailty Journey. She confirmed how joining the Acute Frailty Network enabled them to develop a strategy for Front Door Frailty, have executive buy-in to their vision, and have a support network. Despite the challenges of the Frailty service, Hillingdon Hospitals gave an inspirational account of their work, and reiterated how culture change is imperative for successful integration.  

Next to the stage, we welcomed Walsall Healthcare NHS Trust, presenting A System Response to Frailty in Walsall, by Dr Simon Harlin. The importance of a whole system approach to frailty was encouraged and evidenced as benefitting patient care. A key point and national ambition for frailty was to ensure that all staff know what to do when presented with a person living with frailty or cognitive impairment. This was demonstrated in the work they are undertaking with Walsall CCG to develop an integrated model for Care Homes.

Our final good practice session of the day was presented by Dr Nigel Beckett, Guy’s and St Thomas’ NHS Foundation Trust, presenting on their response to admissions of frail older people. The presentation was incredibly insightful with case studies on recent frail patients presenting to the unit. Dr Beckett reiterated the importance of good multi-disciplinary team care and support, facilitating safe, same day discharge. Equally, good community links and flexibility were highlighted as essential to success.  

Thank you to all delegates, speakers and exhibitors for their input in the conference and project. Project outputs are available on the members’ area with the summary report being published in March 2019. If you have any Managing Frailty project queries, please contact Josh Davies.