BGS responds to long-awaited publication of proactive care guidance

19 December 2023

The British Geriatrics Society (BGS) is pleased to see that the long-awaited guidance on proactive care, 'Providing care and support for people living at home with moderate or severe frailty', has been published by NHS England today.

Previously known as anticipatory care, proactive care is one of the three original streams of the Ageing Well programme, as detailed in the NHS Long Term Plan, published in January 2019. The other two streams of the Ageing Well programme, Enhanced Health in Care Homes and Urgent Community Response, have both been fully rolled out across England. However, anticipatory/proactive care has been beleaguered with delays and funding problems.
Proactive care is a vital part of helping to delay frailty and maintain older people’s independence. BGS members tell us how important it is to act early rather than waiting until older people are in need of urgent or emergency care. In April last year, we raised concerns about funding for this work being cut and we followed this with a blog series showcasing the difference that these interventions can make for older people. 'Joining the Dots', our blueprint for preventing and managing frailty in older people, highlights proactive anticipatory care as one of seven key touchpoints of care and support for older people across the system. BGS Honorary Secretary, Professor Anne Hendry, has represented BGS on NHS England’s professional reference group advising on this framework and we are grateful to Anne for tirelessly advocating for older people throughout this process.

We welcome the focus of this guidance on people living at home with moderate or severe frailty, for whom the right support from health and social care professionals, voluntary sector agencies and neighbourhood teams can help to delay further development of their frailty. Frailty affects 1 in 10 over the age of 65 and up to half of the population over 85 and it is these groups who are most likely to benefit from proactive care. Many people with frailty will also be living with other long-term conditions, which makes the focus on providing holistic assessment in this guidance very welcome.

However, we remain disappointed that the initial promised funding for this work was cut and has not been reinstated. Integrated Care Systems (ICSs) are struggling with the many commitments they are required to fund. As the recent report from the Chief Medical Officer pointed out, maximising the health and life chances of older people should be considered a national priority. Upstream action to support healthy ageing and proactive care for frailty should be part of the Government’s overall public health strategy with additional funding provided. We urge the Government to allocate funding to allow systems to roll out proactive care. Effective implementation of proactive care will save the NHS money in the long term as it will help older people to remain well without needing costly hospital care.

Professor Adam Gordon, President of the British Geriatrics Society, said:

Proactive care is essential to identifying individuals at risk of deterioration and taking preventative action to help them to remain well for longer. As the guidance sets out, effective implementation of proactive care should reduce the demand for unplanned healthcare, including emergency admission to hospital. We are grateful to NHS England for their significant work in bringing this framework forward despite pressures across the system. However, the document is very light on detail and evidence. Colleagues across the country will need to work hard with commissioners and system leaders to enable sustainable implementation. The BGS Blueprint ‘Joining the Dots' provides evidence and examples of where proactive care has been effectively implemented which colleagues may find helpful for planning."