Frailty services expansion to build on improved
performance.
The national roll-out of specialist frailty services at all 30
A&E departments will build on recent progress to clear long
waits and help reduce hospital stay length for the most
vulnerable people.
Frailty Units are specialist beds that focus on intense
assessment of older people with frailty – the services offer
access to specialist skills and care plans, accelerate early
discharge and look to reduce delays and length of stay.
The expansion, supported through the £200 million announced as
part of the 2025-26 Budget, will be a key focus of the Scottish
Government's new Operational Improvement Plan for the NHS, due to
publish this Spring. This will include changes to the way acute
services are delivered to help reduce waiting times. In recent
weeks Health Boards have reported significant progress against
long waits, including:
- the pledge to carry out 64,000 procedures through £30 million
additional funding by the end of March 2025 has already been
exceeded – with boards reporting to have 75,500 delivered by end
of January 2025.
- a 4% decrease in the total waiting list size for diagnostics
– with waits now at their lowest since October 2021
- a 12% decrease from a recent peak in April 2024 in total
ongoing waits for eight key diagnostic tests combined
- 90.6% of Child and Adolescent Mental Health Services (CAMHS)
referrals being seen within 18 weeks from October to December–
the standard is 90%.
On a visit to Glasgow Royal Infirmary, Health Secretary outlined the Scottish
Government's plans to build on this progress by installing a
frailty service in every site with a core A&E by the summer.
Mr Gray met staff working in the hospital's dedicated frailty
service which has reported significant progress in the last 18
months – with average length of stay for vulnerable patients
reducing by 3 days, without any increase in readmission. The
service has also reported enhanced co-ordination and
collaboration among healthcare teams leading to improved patient
outcomes.
Mr Gray said:
“In recent weeks we have seen good progress in reducing waits and
there are encouraging signs that our plan is working. However, we
know there is more to do and we want to drive further
improvement. That is why we are investing £200 million to help
clear waiting list backlogs, improve capacity and reduce delayed
discharge.
“I was pleased to meet the team working in the Glasgow Royal
Infirmary frailty service and see first-hand the positive impact
their crucial work is having – with the service allowing speedier
assessment of vulnerable people presenting at A&E and
reducing length of stay for patients significantly.
“We want to replicate this success across Scotland and shift the
balance of care from acute, to community. Through a portion of
our £200 million investment, we will deliver direct access to
specialist frailty teams in every A&E by this summer. This
will enable people who experience frailty to be referred directly
by GPs and the Scottish Ambulance Service to specialist frailty
services as an alternative to attending A&E or admission.”
Laura Duffy, Consultant Geriatrician at the Glasgow Royal
Infirmary, said:
“Working with our colleagues in the Emergency Department and
Acute Assessment Unit, we have created a process which identifies
people living with frailty. This enables us to direct and
prioritise these people to receive care from a specialist team,
in specialist areas and initiate early Comprehensive Geriatric
Assessment. A key part of developing this service has been
ensuring that we identify the priorities and concerns of our
patients and their carers promptly and work in partnership with
them to develop a plan for their care.
“We have also worked at further developing and enhancing our
links and interface working with our colleagues in the community
and in social care. We have developed daily CGA Huddles which can
be attended by a variety of acute, community and social care
teams. These allow the early exchange of key information and
collateral information gathering about patients, which helps
provide more effective, timely and patient centred care.
“The results so far have been promising with 74% of patients
admitted through the Acute Medical Receiving Unit being screened
for frailty. We have also noted a reduction in length of stay of
three days for people with frailty, without an increase in
readmissions.”
Background
There are currently five frailty units - these have been set up
during the Focus on Frailty programme led by Health improvement
Scotland across Ayrshire and Arran, Lanarkshire, Tayside, Glasgow
and Dumfries and Galloway. There is variation in these services
with no standard model. The services provide a dedicated closed
unit or area staffed by frailty / medicine of the elderly staff
with frailty assessment within the first hour of arrival at
hospital.
In April 2024 the Scottish Government funded NHS boards to
deliver 64,000 procedures (40,000 diagnostic procedures, 12,000
surgeries and 12,000 new outpatient appointments) by March 2025.
By 31 January 2025, 56,500 diagnostic procedures, almost 9,200
surgeries, and over 9,800 outpatient appointments had been
delivered.
