- The Frailty and Dementia MSF should acknowledge the importance of prevention of both conditions with an emphasis on healthy ageing throughout the life-course and in older age.
- The recommendations of the Frailty and Dementia MSF should give equal standing to frailty and dementia.
- Identification and diagnosis of frailty and dementia should become standard practice, using tools such as the Clinical Frailty Scale and Electronic Frailty Index. This should include identification and diagnosis across primary, community and acute care settings with ambitious targets set for diagnosis rates.
- The MSF should highlight the value of proactive care and early intervention, particularly for older adults living with frailty.
- The MSF should set ambitious targets for availability of post-diagnostic support for people with dementia and action to delay the progression of frailty.
- Social care plays a vital role in care for older people living with frailty and dementia. The social care sector should be an integral part of the MSF with clear details on how health and social care will be better integrated to support people living with frailty and dementia and how the MSF will be integrated with the Casey Commission.
- The MSF should take a holistic approach incorporating the physical, mental, social and function needs of the individual. This should include support for their unpaid carer and recognition of the carer’s needs.
- Most people living with frailty and/or dementia will not only be living with this condition. It is vital that due consideration is given to integration with care provided for other long-term conditions associated with ageing.
- The MSF must keep innovation at its heart, ensuring that developments in the diagnosis, treatment and care for people with frailty and dementia are made available in a timely manner and steps are taken to improve the participation of people with lived experience in research.
- The health and social care workforce must have the skills needed to care for a population with increasing levels of frailty and dementia. Training and education in both conditions must be mandatory for healthcare professionals across most specialties (exceptions for obstetrics and paediatrics) at all levels.
- Due consideration must be given to the provision of end of life care for people with frailty and dementia, including honest conversations about end of life and advance care planning. The Frailty and Dementia MSF and the Palliative and End of Life Care MSF must be aligned.
- The MSF must commit to providing as much care as possible for people living with frailty and dementia in neighbourhoods and community-based settings, supporting people where they are. This should be balanced with the availability of timely hospital-based care when clinically appropriate.
- The MSF should establish clinical standards that address regional variation and ensure that all older people across England receive a consistent minimum standard of care in terms of identification, diagnosis and follow-up of both frailty and dementia, regardless of where they live.
