Last week I nominated the North West Surrey Integrated Frailty Team for an NHS Parliamentary Award for Excellence in Healthcare. The team are delivering co-ordinated, patient-centred care, which maximises independence for people living with frailty. This includes:
-
a single access point, open 8am-8pm, seven days a week, linked with 111 making access to the right support easy for patients and staff
-
Multi-disciplinary teams in Frailty Hubs
-
Hospital at Home – hospital level care with remote monitoring
-
Home First and Frailty Teams – at front door reducing unnecessary admissions, supporting integrated discharge
-
Urgent Community Response Team – supporting people at risk of admission within 2 hours
-
Integrated discharge bureau – including mental health teams to reduce long stay patients
-
Step down accommodation for people medically fit but needing help after discharge
-
Integrated older persons advice liaison teams supporting all specialties, including mental health and surgery in acute trust
There are estimated to be around 40,000 people living with frailty in North West Surrey, and the work of this team is delivering huge benefits in both quality of care and outcomes. Since December 2020 north west Surrey has seen a 12% reduction in admissions for dementia, UTIs, falls and catheter related issues. There has also been a reduction in length of hospital stays, including a reduction in 30 day admissions.
Emma Wilkinson, Consultant Geriatrician at Ashford and St Peter’s Hospitals and Clinical Director of Frailty for North West Surrey Alliance, said:
The incredible impact of the NHS and wider healthcare services means that our life expectancy has significantly increased. For those living with frailty and their loved ones this can be an extremely challenging stage in life and our aim is to provide care that delivers the quality of life and independence we know is so important to them. Through our collective innovation and determination we have shown the tangible difference that can be made when we shift our approach to one of early intervention, integrated working and paying careful attention to each individual’s wishes at every touchpoint with health, care and wider wellbeing services.
Recognising this example of what can be achieved when we break down organisational barriers and work as one team with the same goal is crucial for its sustainability and spread and we welcome the support for our efforts.
In addition to this amazing work locally, the Integrated Frailty Team are also sharing their approach to benefit other teams across the country. I am delighted to be able to help recognise this fantastic work, and the team who deliver it, and wish them the best for the awards!
