Helen Lyndon, Nurse Consultant, Clinical Lead for Frailty at NHS England, discusses how new care models will re-design services for older people with frailty.
This presentation was filmed at our event Delivering integrated care for older people with frailty on 15 March 2016.
It’s fantastic to be in a room with all of these people talking about older people with frailty. I think probably two or three years ago people might have heard of the word but didn’t really know what it was. And if they did know what it was, well, so what? What can we do? And I think that's really changed, it feels like the time has come. Thinking about an older person living with frailty as any other long term condition. We know it’s really common, we know that once people are 80 between a quarter and a half of them will display some degree of frailty. We know it’s progressive and that's really interesting because often frail older people present a surprise to us, don’t they? Present in the emergency department with one of the frailty syndromes perhaps, or to community services, or to their GPs, but actually frailty takes between five and 15 years to develop. So the clues are there much earlier. This is why we need to think about much more preventative proactive work.
We know like any other long term conditions things go wrong, there are episodic deteriorations, and those are where we see people displaying the frailty syndromes. So things like delirium, falls, immobility that happen suddenly and affect people’s ability perhaps to manage at home and remain independent. We know there are lots of preventable components to frailty and many of you will have read the NICE guidance that came out late last year around preventing frailty and dementia in later life. Very much around lifestyle changes that people can make particularly in midlife to prevent or to reduce their chances of developing frailty in later life.
And I guess what I see day in day out as a clinician is the impact on people’s quality of life of becoming frail. Suddenly not being able to manage independently, not to be able to get out to engage socially, to be as mobile as they were and, of course, we know it’s expensive. Frail older people are still the highest users of health and social care. But I would imagine most of us now have at least had a look at the five year forward view.
But I guess the key things for me is that focused on managed systems, having networks of care. It’s not about organisations, it’s about what we need to do for that patient, wrapping that care around the patient. And it clearly says that our hospital care needs to become a much larger part of what the NHS does. We also need to learn really much faster from best practice examples. And I guess that's what’s been really clear to me, again, over the last couple of years getting out and about is there's fantastic work going on out there. But as we introduce them we need to evaluate those new care models and make sure that they are producing good experience to patients, but also, of course, best value for money. And this is where the vanguards come in, the new care models. Now, of course, not all those new models of care will focus on older people with frailty but when I read the proposals for all of those vanguard sites I would say 95% of them are.
The other thing that we’ve worked really hard to get this year is a local sequin for frailty so a quality payment that commissioners can use in collaboration with their providers to start some of the work on implementing system wide change for frailty. We’ve got it into the local CCG pick list and it really looks at how we identify frail people, how we assess them, how we make sure they have personalised care and support plans in place and how that information is shared across all systems. We’ve also worked with Public Health England and our colleagues in Scotland around a frailty joint action with the European Union.
So what the European Union want to do is to bring together many of the countries to really do some focused work around new models of care for frailty. And our bid was successful and we’ll be looking at some of the new care models but also some preventative work for frailty.
The other really interesting piece of work which is just about to publish is the older peoples’ outcome set. So, again, talking to CCGs, talking to providers, everybody wants to come up with the correct outcomes for their work. So NHS England commissioned the National Consortium for Health Outcome Measures, ICHOM, to do some work and they put together an international steering group to look at the best evidence outcome measures that are out there.
And the other two things that we’re working on specifically around frailty is the summary care record. We have now an enhanced summary care record where GPs can add additional information. What we’re doing is putting together a frailty scenario. So what would work as part of the enhanced summary care record for frail older people. So particularly things like level of frailty and making sure the personalised care plan is part of that enhanced summary care record.
And the final thing is working with Right Care who are looking at unwarranted variation. We’re putting together an optimal pathway for frail older people which looks at what would be the ideal pathway to support a frail older person and looking at the costings across all sectors to make sure that we think about how resources need to change to support that optimal care pathway.