The British Geriatrics Society has welcomed a new GIRFT (Getting It Right First Time) national report on geriatric medicine, which identifies unwarranted variation in the provision of geriatric medicine across England and in hospital care for people living with frailty.

The report advocates a population-based approach to frailty, where trusts work closely with partners across the system to provide joined-up care and alternatives to hospitalisation, to improve quality of care for older people.

The BGS says adopting this approach is especially important in light of the Covid-19 pandemic. The report calls for a collaborative approach across whole systems including primary and secondary care, care homes, community services, ambulance services, local authorities and the voluntary sector.

Key recommendations aim to prevent and manage frailty and to provide appropriate community alternatives to hospital if safe and effective care can be offered at home or closer to home. 

The report also contains measures aimed at improving end of life care to help ensure that more older people can be looked after and die in their preferred place of care wherever possible. This is intended to reduce unplanned and avoidable admissions to hospital towards the end of a patient’s life.  

Improving health outcomes for older people

Measures recommended in the report have the potential to both improve outcomes for older people across England and to reduce acute care costs for the NHS by up to £687 million, primarily through a reduction in hospital bed days.

Key recommendations in the report include:
  • Stronger leadership and training: The report states that some falls, medicine errors, pressure ulcers and infections could be avoided if all trusts appoint a senior member of staff to lead on frailty care, overseeing safety issues, quality of care, staff training and awareness. The report also recommends that all staff caring for older people in hospital or in the community should have basic training to enable them to spot risk factors for frailty.
     
  • Better management of outpatient appointments: The report encourages the further development of online appointments and virtual outpatient clinics, with appropriate support. Where in-person appointments are needed, trusts should aim for a co-ordinated ‘one-stop shop’ approach, so patients have all the appointments they need on the same day wherever possible.
     
  • Avoiding hospital-acquired deconditioning: The report calls for trusts to better identify patients with mild or moderate frailty to prevent them becoming severely frail, providing the support, equipment and facilities they need to get out of bed, dressed and moving each day.
     
  • Improving delirium pathways: Delirium can cause inpatient falls and longer stays in hospital, but some older patients who arrive at hospital are not assessed for the presence of delirium, especially if they arrive out-of-hours or at weekends. The report recommends trusts have a clear pathway for delirium, which includes early identification and assessment, to help improve patient safety.

In addition to improving health outcomes for older people, implementation of the report’s recommendations can reduce costs by decreasing avoidable hospital admissions and outpatient attendances and reducing lengths of stay in hospital. For example, the report shows that if trusts can avoid duplication of new and follow-up outpatient appointments using a ‘one-stop shop’ approach, up to £186m could be saved for the NHS.

President of the BGS, Dr Jennifer Burns, said: "We warmly welcome this national report and strongly believe implementation of the recommendations has the potential to improve quality of care for older people and can help to realise the ambitions of the Ageing Well programme.

"We commend the report for acknowledging the importance of professional leadership in developing well co-ordinated, person-centred care across and between primary care, community services, hospitals and care homes.”