Is Wessex Frailty Fit?

Cheryl Davies has worked for the NHS for over 19 years. Her background is in statistics and has worked in information analysis both nationally and at a local commissioner level. She tweets @CherylDavies22 Lucy Trubacik is a Project Manager with the NHS Benchmarking Network, the in-house benchmarking service of the NHS, and facilitates their annual benchmarking projects. She tweets @nhsbenchmarking @Lucy_NHSBN

Do you know how many people in your hospital are living with frailty? Do you know where these patients are in your hospital? Why does it matter?

Understanding how our local health systems can support patients living with frailty will be fundamental in delivering the Long Term Plan, but the question remains: what does frailty look like in Wessex (the fastest growing population of over 65s in the UK)? Do we really know how many patients are living with frailty in our hospitals within the region?

By understanding the incidence of frailty in our hospitals, we can reduce the unintended variation in care and focus resources where they are needed, therefore increasing the quality of care across the region.

In 2018, the Healthy Ageing Programme at the Wessex Academic Health Science Network (AHSN) and the NHS Benchmarking Network (NHSBN) collaborated on a piece of work, pulling together two separate data collections.

The Wessex Acute Frailty Audit focused on the themes in the NIHR Dissemination Centre’s themed review “Comprehensive Care: Older People living with frailty in hospitals”, collecting data from nine acute trusts and one community hospital (58 wards in total). The audit aimed to identify and understand the variability in screening, identification, management, discharge and workforce across the whole hospital.

The NHSBN Managing Frailty and Delayed Transfers of Care in the Acute Setting benchmarking project focused on the pathway of frail older people through secondary care and allowed organisations to compare their provision at a national level in order to understand how frailty was managed in the acute setting and improve service delivery.

Despite different objectives, both organisations had the common goal of aiming to understand and identify opportunities to improve patient care for those living with frailty, with a view to identify areas of best practice and opportunities for service development. Key themes emerging from both datasets were:

• Screening and identification of frailty: screening for frailty happens at the emergency department front door, but rarely for direct ward admissions or after admission.

• Management and discharge: the NHSBN dataset showed that Wessex is performing higher than the national average for older people having a CGA (Comprehensive Geriatric Assessment) started within one hour of admission; the Wessex Frailty Audit identified that outside of Medicine for Older People wards, some Emergency Departments and Acute Medical Units, CGAs are not routinely carried out and rarely involve the patient or carers.

• Training and workforce: there is a richer therapy skill mix within Wessex Trusts compared to the national position, as well as greater availability of medical cover in A&E and frailty units. The audit found that there is presently no requirement for Trusts to deliver induction or mandatory training relating to frailty and there is little participation in this area.

NHSBN and Wessex AHSN held a successful workshop on 26th February 2019 with local acute executives and geriatrician leads to review the outputs, interpret the findings at a local level, and identify service improvement opportunities that had been highlighted from the data. Trusts were also encouraged to share good practice and to agree local action plans to drive service improvement. The Wessex participants received bespoke reports highlighting their positions against the Wessex and the national positions, as well as access to an online benchmarking toolkit.

The power of pulling two datasets together has provided a comprehensive picture of frailty provision across Wessex and has generated local and national interest via #WessexFrailtyFit. The local audit has provided added value to the national benchmarking data collection by providing organisational context and depth, as well as a framework for measuring improvement. It has also stimulated discussion in Wessex on differences in service provision locally.

The momentum across Wessex continues; working groups have been set up to focus on and support service improvement projects, with particular attention being paid to training, to ensure that every Wessex Trust has a richer understanding of how our patients are managed.

For more information on the Wessex Frailty Audit, please contact the Healthy Ageing team at healthyageing [at] wessexahsn [dot] net

To find out more about the NHSBN project, please contact josh [dot] davies [at] nhs [dot] net. The NHSBN’s project will be running again in the 2019 benchmarking cycle.