Staff across Pennine Lancashire Integrated Health and Care Partnership come together to improve care and support for people living with frailty

Published May 15, 2018 at 8:27

On 4 May 2018 staff from across Pennine Lancashire Integrated Health and Care Partnership came together at Walshaw House, Nelson, to look at how services delivered by organisations across the partnership, can better support and co-ordinate health, care and support services for local people living with frailty

Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves.  Older people living with frailty are at risk of adverse outcomes such as dramatic changes in their physical and mental wellbeing after an apparently minor event which challenges their health, such as an infection or new medication.

The Pennine Lancashire Frailty Model has been developed over the last 12 to 18 months through a series of workshops, and working groups exploring the development different elements of a whole system model.   Through this development and exploration phase it was felt that the common tool and approach to be used across Pennine Lancashire would be the Rockwood Clinical Scale as identified through the Canadian Study of Health and Aging.  Patient case studies and stories and input from families and carers have also contributed to the Frailty Model and priorities.

The three key elements of the Frailty Model are:

  1. Awareness and identification – to raise awareness of frailty including prevention, and the services available for different frailty levels.
  2. Assessment and Care Planning – Shared/trusted assessment which includes the Rockwood Clinical Scale for frailty and falls.
  3. Review and Communication – Reviews will be carried out to ensure the right care is in place at the right time, and communicated consistently

Dr John Dean, Deputy Medical Director and Consultant Physician at East Lancashire Hospitals NHS Trust, said:

This event was planned as part of a series of organisational development sessions for our Neighbourhood Health and Wellbeing Teams. It was a fantastic opportunity which helped to strengthen professional relationships and collaboration between community, primary care, social services and acute care staff. This work will provide an improved co-ordinated approach to the Pennine Lancashire Frailty Model.

Grouped in Neighbourhood Teams, staff looked at a scenario based case study of an experience of the health and care services by a resident living with frailty. Discussions took place around what personalised care and support should look like and how as an Integrated Health and Care Partnership we could holistically provide health, care and support through our New Model of Care which places people and their families at its heart.

We will take forward the key areas for action and improvement as we look to further develop our partnership working to better support and co-ordinate health, care and support services for local people living with frailty.