Wessex Acute Frailty and Community Frailty Audit

Following on from the publication of the National Institute for Health Research (NIHR) Dissemination Centre ‘Comprehensive Care: Older people living with frailty’ themed review in 2017, the Wessex Acute Frailty Audit looks at the standard of care that is provided for a person living with frailty in our local acute hospitals. 

The project was run by Wessex Academic Health Science Network (AHSN) in collaboration with 8 acute trusts (covering 9 hospital sites) and a community hospital (which has some acute beds) to gain a regional understanding of care provision. 

The audit aimed to identify areas of good practice and also significant gaps in frailty identification, personalised assessment and care planning, and hospital wide provision of frailty training with an overall aim to regionally drive up standards of care and improve patient outcomes.

The audit and subsequent workshop identified gaps in frailty service provision and opportunities for service improvement across Wessex. Two clinical working groups were convened by Wessex AHSN Healthy Ageing programme as a result of the audit outcomes.

Outputs included: 

• The development of Frailty awareness and training tools to support Tier 1 and Tier 2 Skills for Health Frailty Competency Framework https://www.skillsforhealth.org.uk/services/item/607-frailty-core-capabilities-framework
• Development of a Wessex AHSN best practice standards for frailty screening, capture of frailty identification, and the sharing of information with all clinical stakeholders (hints and tips)
• Development local case studies showcasing delivery of best practice for frailty screening, identification and sharing of information

The development and completion of the audit has also enabled the following opportunities:

• Sharing of knowledge and experience of the audit journey with other AHSNs and clinicians
• Consideration of sharing the audit tool with other interested AHSN sites, with a view that Wessex AHSN will seek consent to host the tool to enable national analysis
• Provided a vehicle to promote the outputs of the service improvement projects to promote best practice and spread new initiatives both locally and nationally
• Provision of a platform to influence the national agenda with national frailty leads
• Showcased the collaborative working with Wessex AHSN and NHS Benchmarking to showcase and champion the audit work
• Promotion of the frailty agenda in specialities outside of Medicine for Older People, “The frailty audit we did with the surgical team helped to make contacts and raise awareness” [Trust feedback]

The Healthy Ageing Programme plan to re-audit acute trusts in 2021 and will enable measurement of improvement from the baseline audit in 2018. 

Please visit: https://wessexahsn.org.uk/projects/346/wessex-acute-frailty-audit-autumn-2021 for more details.

National Context and Drivers: Why focus on frailty in the community?

The Wessex Community Frailty audit (WCFA) was developed to compliment the Wessex Acute Frailty Audit run in 2018. The WCFA has the overall aim of providing an overview of frailty pathways across the whole health care system. A panel of frailty experts and system leaders from the Wessex AHSN Community and Primary Care Expert Group supported the development and trial of the approach.

The 2019 NHS Long Term Plan outlines several important changes to the way the NHS should work to support patients and their carers; Improving care for older people living with frailty or multiple long term conditions is one of its priorities and recognises that services are not consistently joined-up or responsive to the needs of older people living with frailty with an overall aim to support people to age well and to stay independent at home for longer.

Why Primary Care Care Networks? 

PCNs are the vehicle for the delivery of the frailty elements long term plan, keeping patients at home and independent for longer, so the audit was developed at PCN to provide a baseline of frailty provision.

What did the audit include? 

To mirror the Wessex Acute Frailty audit, the WCFA comprised of 28 questions relating to five key areas:

1. Screening and sharing of frailty information
2. Frailty knowledge, skills and training
3. Current frailty pathway processes
4. Multi-disciplinary team interactions
5. Service Improvement opportunities

When did the audit take place? 

All PCNs were approached to take part in the audit. 22 PCNs' took part in the audit during October 2019. 

What has the audit shown? 

An interactive workshop was held in February 2020 and provided a forum for PCN Clinical Directors, frailty leads, service manages and Clinical Commissioning Groups and STP leads to review overarching themes form the community frailty audit and to identify potential service improvement projects. 

Key areas of focus for the community include communication, multidisciplinary team meetings, and collaboration with the social and voluntary sector. Presentations from the workshop have been made available. 

A summary of outputs of the workshop and a video of Dr David Atwoods' key note speech has been made available. These resources can be used within your organisation.

An evaluation of the approach was published on the 11th September 2020 and plans for a 2022 re-audit are being discussed.