The announcement that patients over 65 who appear frail at A&E will soon receive ‘health MOTs’ on arrival is an encouraging move. With one in five people admitted to hospital severely frail, it rightfully recognises the need for further support for some of our most vulnerable patients.
This measure could help reduce unnecessary admissions, overcrowding, trolley waits and corridor care. Furthermore, it represents a logical step in the right direction against ‘deconditioning’ which has become a persistent challenge for the system as we know.
With over 65% of older patients in hospital experiencing further decline in function, preventative measures are desperately needed. When frail patients stay longer in hospital than they need to, it can lessen mobility and increase risk of subsequent falls and further readmissions down the line. While the risk of infection also rises.
In response to all these issues, health MOTs will see patients undergo a series of ‘doorstep tests’, after which, care will be provided if required or the patient may be signposted onward to other services as appropriate such as falls or specialist care. Tests will entail assessment of blood pressure, falls history, heart health, mobility and malnutrition.
It is hoped that this level of holistic review may reduce pressure on hospital services and lead to better patient outcomes. And certainly, the approach is in keeping with good practice guidance:
“Identification of frailty at the hospital front door can help trigger early comprehensive geriatric assessment and ensure that older people with frailty are diverted to the most appropriate services within the hospital as quickly as possible and, where possible, discharged home on the same day.”
- British Geriatrics Society, Front door frailty: Advice on setting up services
It’s been reported that AE staff have expressed caution that the move fails to recognise root causes for long waits such as limited beds and capacity in A&E. And alongside the announcement, there has been commentary that frail patients are often not getting the support they need for well-planned, joined-up care.
While this initiative is right to recognise the need for earlier intervention, could we intervene further upstream and provide additional support to urgent care services grappling with capacity pressures? For example, we know that care closer to home can have benefits for frail patients who are often living with multiple conditions.
“Supporting people with frailty at home is often beneficial for the individual, who is able to stay well and independent in familiar surroundings for longer, as well as their family and friends who support them. It can also reduce pressure on the wider health and care system and support patient flow.”
- NHS Confederation, Supporting people with frailty
Indeed, we’ve seen the results virtual wards have delivered in regards to outpatients, providing hospital-level care and enabling a multi-disciplinary approach that keeps patients out of hospital. But what about at a primary and more intermediate care level before patients present to A&E?
This is where virtual clinics can help ICBs and primary care services with proactive identification and ongoing management. Adopting an approach consistent with NHS England proactive care frameworks, clinics can deliver five core components of care identified as best practice.
These are:
This is exactly how Suvera has supported partners like South Central Ealing PCN.
Utilising SystmOne data, we created a register of patients who were high intensity users, and/or are vulnerable or frail. Our team then identified who would benefit from a care plan or require multi-agency support.
Clinical pharmacists delivered holistic frailty reviews and co-developed care plans in partnership with patients and carers. This included review of medication and dementia as well as provision of optimal strategies to manage conditions. The service achieved the PCN target of 1000 care plans for patients and saw patient engagement rates of 74% in response to proactive outreach.
With sub-optimal management of severe frailty estimated to cost the system up to £2100 annually per person, 1000 patients on optimal care plans could potentially deliver up to £2.1m in savings to the NHS every year while preventing admissions.
Not only that, but such an approach could serve as a complimentary model to A&E MOTs and virtual wards, providing more joined up care at all levels of the system for frail patients. And, as we have seen for some time now, this is something that’s desperately needed if we are to fully realise better outcomes for our most vulnerable in society.
