Learning session 3 event summary

Focus on Frailty programme learning session 3 - event summary

Wednesday 8 May 2024

Learning session three of the Focus on Frailty programme was attended by 71 delegates. All six Focus on Frailty teams attended alongside colleagues from Public Health Scotland, the Scottish Centre for Simulation and Human Clinical Factors and the Right Decision Service.

The aims of the session were to:

share and explore each team’s progress and change ideas,
connect and learn as part of the Focus on Frailty programme, and
plan next steps for testing change ideas and spreading what works.

Chair's welcome

Dr Lara Mitchell, National Clinical Lead for Acute (Frailty) chaired the event. Dr Mitchell welcomed the teams and set the scene for the day. Attendees were asked what they hoped to achieve in the last seven months of the programme. Responses included:

“Influence national conversation to prioritise primary intervention and early intervention.”

“Better understanding of our patients’ experience.”

”Prevent hospital admission by early community intervention.”

“A functioning frailty unit where we are seeing the right patients at the right time.”

Team presentations

Highlights from the team presentations included:

North Lanarkshire HSCP and NHS Lanarkshire	Established a frailty network with representation from community, acute and the third sector. Improvement work is underway around frailty identification and assessment in three acute sites, with different models. Each site is reporting improvements in frailty identification. Patient journeys and experience stories being captured.
Glasgow Royal Infirmary and NHS Greater Glasgow and Clyde	Development of the team - better integration and collaboration. Focus on identification at front door and established a frailty assessment unit. Comprehensive Geriatric Assessment (CGA) huddles established. Improved frailty identification and access to CGA. Staff education and awareness programme. Patient experience case studies being captured.
Perth and Kinross HSCP and NHS Tayside	Focusing on improving transition from secondary to primary care. A single point of contact/discharge coordinator is being tested. A new electronic discharge document has been developed to improve communication between primary and secondary care. Staff feedback has helped challenge assumptions on knowledge and skills. Staff awareness sessions have been in high demand.
Dumfries and Galloway HSCP and NHS Dumfries and Galloway	Time spent creating conditions and understanding the system. Focus on integration of community teams. Set up four workstreams: Early identification – education and training to establish shared language and understanding of frailty. Proactive planning - testing polypharmacy work in one GP cluster. Transitions in care - pre-admission geriatrician input (call before conveying to hospital.) Ageing well – an ageing well toolkit in development.
Moray HSCP and NHS Grampian	Consideration of high-risk patients and development of an ageing well review. Testing of Making Every Opportunity Count (MeOC) frailty tool to support social prescribing and community connections. Success with Moray flow huddle multidisciplinary daily meeting. Progress on implementing frailty icon use in acute Grampian wide. Use of Scottish Therapeutic Utility data to target polypharmacy reviews in GP practices.
South Ayrshire HSCP and NHS Ayrshire and Arran	Publication of an ageing well strategy focused on a population-based approach. Specialist District Nurses and Advanced Nurse Practitioners offering proactive CGA. Using Rockwood as an indicator for person centred Future Care Planning (FCP) conversations. Enhanced documentation process for conversations between community nurses and patients about their preferences for their preferred place of care at end of life and recording on Key Information Summary. Creation of a self-assessment tool and early intervention advice. Care at home staff trained to identify frailty and make referral to care at home teams.

World café

A world café session provided attendees with an opportunity to network and exchange ideas. The discussion covered the following:

Avoiding admission	A direct point of contact for GPs to explore whether clinical or social care can be provided by a community team comprising of nursing, pharmacy, and home care. Setting up integrated end of life community nursing teams. Step-up beds. Challenges included providing out of hours and weekend cover for initiatives to support admission avoidance.
Front door frailty	Maximising the contribution of pharmacy in CGA huddles. Models for frailty assessment units/teams: shared challenges in processes, team, and culture. Progressing towards a frailty icon.
Data and measurement	Quantitative and qualitative data are crucial to understanding if the changes being tested are having an impact. Using data to influence strategic leadership opens doors, builds team confidence, and grants teams’ permission to proceed. Develop culture, leadership and good decision making backed by good quantitative and qualitative data visualisation.
Identification and assessment in the community	More focus on prevention. Resources for health and social care professionals to help signpost. Need for a national campaign on frailty. Over 50s screening such as bowel and breast screening could include advice to prevent frailty.
Transitions of care	Improving communication is the key to better transitions of care and improving patient experience. The importance of understanding each other’s roles across the system. Minimising duplication of work and creating one journey for the patient. Frustration with current IT systems and addressing this both short and longer term.

Workshops

The afternoon session started with a choice of three workshops. A summary of each workshop and links to related resources are below.

Workshop 1: Frailty simulation: how to use simulation to make a success of improvement work.

Dr Julie Mardon from the Scottish centre for simulation and clinical human factors shared two examples of how simulation, psychological safety and debrief can be used to support team development and improvement. These included a flash card scenario on the clinical frailty scale and a falls simulation in which someone had recently been discharged from hospital to their own home and needed falls prevention support.

Workshop 2: Ageing Well: developing a toolkit for health and social care staff.

Eileen Jennow from Public Health Scotland spoke about why physical activity matters and the national physical activity pathway. This provides advice on activity levels and muscle strength and how interventions are linked to the Rockwood score.

Lynne Mann, Lead AHP, Community Health & Social Care, NHS Dumfries and Galloway shared their Active Life Pathway which was developed based on the Public Health Scotland pathway. The pathway will be based on the five pillars to ageing well but will initially focus on physical activity.

Workshop 3: Using lived experience data to influence change.

North Lanarkshire HSCP and Glasgow Royal Infirmary teams shared their use of patient experience data. This qualitative data is valuable in challenging assumptions and ensuring changes are person centred. Patient stories help evidence that changes are benefiting patients and can be powerful in motivating teams and influencing decision makers. More information and resources are available from the person centred design and improvement team.

Leadership and culture to support integrated working

Belinda Roberston, Associate Director for Improvement, Healthcare Improvement Scotland delivered a session on leadership and culture to support integrated working. Belinda shared a framework from NHS improvement on leadership to support improvement. Attendees were asked to consider what action they can take to improve leadership and culture in their own teams. Responses included:

Keep banging the drum. Sharing data and intelligence with national and local leaders." Learning session 3 attendee

Closing remarks

Dr Mitchell closed the day a message of encouragement for each team emphasising the importance of making a plan to sustain their improvement work beyond the lifetime of this phase of the Focus on Frailty programme.

Evaluation

100 % of respondents strongly agreed or agreed that the team presentations enabled them to learn from the work of other teams and reflect on their own improvement work.
90% of respondents strongly agreed or agreed that the world cafe provided an opportunity to make useful connections with colleagues in other teams.
98% of respondents strongly agreed or agreed that the learning session helped build resilience and momentum with their frailty improvement work.

Feedback from event attendees included:

Another great event with likeminded frailty focused colleagues." Learning session 3 attendee

If you have any questions, please contact us via email at his.frailty@nhs.scot