New approach needed to frail elderly care

Professor John Young, NHS England’s Director for Integration and Frail Elderly Care, today told a high-powered Westminster Health Forum that a new “Frailty Index” is needed to help improve services for older people.

Professor Young told the seminar that better recognition of frailty as a long term condition is key to the future care of Britain’s aging population.

He told delegates: “There is an over-reliance on secondary care responses, with over 650,000 people over the age of 65 attending hospital emergency departments each year after suffering a fall.”

Professor Young suggested a “Frailty Index” be introduced that would enable people with frailty to be identified and to grade their frailty state, and individualised care planning be devised for people.

“Frailty is complicated. Frailty is the inner vulnerability and loss of inner reserve. People with frailty don’t bounce back up easily and sometimes don’t ever get back to where their health was.

“The question is, can we detect frailty more upstream and work around prevention and pro-active care. We currently have this predominantly hospital-based care for people with frailty. But if we conceptualise frailty as a long term condition it means we can think about pro-active and preventable care programmes.

“It’s an ambitious vision. But we want to empower people so they can promote their own independence later in life.”

Professor Young added: “The primary care electronic Frailty Index (eFI) is a simple tool that’s coming our way soon.  The basic principle going forward is that we deal with frailty in the same way that we are dealing with people with dementia. We must engage people in the care planning process in a way that we never have done before.

“If we are to deliver these principles and this ambitious vision, it needs to involve multi-sector working and us all working together.”

The seminar, chaired by Baroness Greengross, Chair of the All-Party Parliamentary Group on Dementia, heard from series of speakers including Dr Charles Alessi, chairman of the National Association of Primary Care, who spoke about the commissioning of elderly care services and the role of the GP.

Dr Alessi said: “What we are trying to do with commissioning is go back to a time when general practice was about building relationships between people rather than just a doctor and patient.

“I am optimistic about the future – and that’s because we have no money. If we had money, we would have had a pilot on a dysfunctional system, and I don’t need tot ell you how that would have worked.”

Dr Linda Patterson, past clinical vice president of the Royal College of Physicians, added: “The acute hospital sector looking after elderly people takes up a lot of resource and I don’t think we’ve got it right.

“The issues around the care of older people and an ageing population have led to increasing hospital admissions. 25 per cent of people in hospital have dementia and many older people have more than one condition.

“The social care and health care boundaries have become blurred. But if we get it right for older people, particularly those with frailty, then we will get it right for everyone.”